This magazine is published by the Association of Salaried Medical Specialists and distributed by post and email to union members.
Executive Director: Sarah Dalton
Magazine Editor: Andrew Chick Journalist: Matt Shand Designer: Twofold Cover Image: Shutterstock
The Specialist is produced with the generous support of MAS.
WANT TO KNOW MORE?
Find our latest resources and information on the ASMS website asms.org.nz or follow us on Facebook and Twitter.
Also look out for our ASMS Direct email updates.
If you have any feedback on the magazine or contribution ideas, please get in touch at asms.org.nz
PREFER TO READ THE SPECIALIST ONLINE?
We have listened to your feedback and are aware that some members prefer not to receive hard copies of the magazine.
If you want to opt out of the hard copy, just email membership@asms.org.nz and we can let you know via email when the next issue is available to read online.
ISSN (Print) 1174-9261
ISSN (Online) 2324-2787
The Specialist is printed on Forestry Stewardship Council® (FSC®) certified paper.
The Specialist is printed on FSC certified environmentally responsible paper stocks manufactured under the environmental management system standard AS/NZS ISO 14001 using Elemental Chlorine Free (ECF) pulp sourced from sustainable well-managed forests. Processes for manufacture include use of vegetable-based inks and water-based sealants, with disposal and/or recycling of waste materials according to best business practices.
Printed by: City Print, Wellington, New Zealand
A VALUE STATEMENT
KATIE BEN, PRESIDENT
The only time a hospital is cost efficient is when there are no patients in it. As soon as a patient walks through the door you need staff to treat them. As soon as you start treating people you need equipment.
In fact, the most cost-effective hospital we can ever build would be a windowless building ideally with the doors nailed shut to prevent pesky patients trying to access health services.
With no patients we don’t need doctors, nurses, allied health, administration, cleaners. The cost savings are immense. So, if cost saving is the goal, that is the answer.
All around us hospitals are being seen as a cost to be reduced. We have bean-counters talking about productivity, efficiency and run-rates – and everything is being measured in dollars.
Instead, they should be focused on value. In the ongoing discussion about health efficiencies, Te Whatu Ora’s managers have forgotten that. No clinician is going to be proud to deliver health outcomes of less value, no matter how much money the hospital saved delivering it.
As clinicians, cost does not come before dealing with sick patients. We are thinking first about providing good wrapround services and equitable access to the health care system.
But we are up against Government policies that seem to value senior doctors less than they value landlords ($2.9 billion) or the tobacco industry ($216 million).
Senior doctors have been valued at $165 million in our recent ‘pay package uplift’. To me that indicates they
are more interested in the revenue from making people sicker than they are in any form of expenditure to improve health outcomes.
A form of nailing the doors shut.
How little they understand the value of their senior staff is, quite frankly, insulting.
Every SMO I have spoken to says the same thing and usually follows this up with a Google search about “How easy is it to transfer medical qualifications to Australia?”
Health must be about value and not cost. Otherwise, the price we risk paying won’t be measured in dollars, but in our own health and mental wellbeing. As your union, we are committed to demonstrating the value of investing in health and investing in our senior medical workforce, for as long as it takes to get people to listen.
Te Whatu Ora’s latest bargaining parameters send a clear message that the work we do, the overtime we do and the effort we put in to add value to a health system that we see is crumbling around us is not being recognised by our employers.
Our productivity is only being measured as a cost. A valuebased approach is needed, and it is time we demanded decision makers speak about value instead of being obsessed with the run rate.
All around us hospitals are being seen as a cost to be reduced. We have bean-counters talking about productivity, efficiency and run-rates – and everything is being measured in dollars.”
A CHRISTMAS TURKEY
SARAH DALTON, EXECUTIVE DIRECTOR
As we approach the silly season, the grim failure of Te Whatu Ora’s leadership inability to address the health workforce crisis is – sadly – the gift that keeps on giving.
I met with Te Whatu Ora Chief Executive Margie Apa in October to talk about Te Whatu Ora’s financial crisis. Margie told me – very directly –she knows we do not have enough doctors across our health system. We can agree on that.
But she also told me there is very little she can do about it, there is no more money, and we must “live within our means”. In doing so she also explained that the staff shortages identified in last year’s workforce plan were never linked to this year’s budgets.
How is that possible? When 1,700 doctors are identified as missing from our health system, Te Whatu Ora made no account for this in its 2024 budget. No one should agree that is acceptable.
If you are in a service that is currently short staffed – probably some combination of unfilled vacancies and unbudgeted shortages – the implications of this are bleak. Not only has Te Whatu Ora put a handbrake on recruitment, it also never made provision to address known staffing gaps in the first place.
Meanwhile, as Commissioner Lester Levy declares no cuts will be made to the frontline
on his watch, we have $30 million taken from the budget of the National Public Health Service. It’s as though Covid taught them nothing.
And what of the new regional deputy chief executives? They have not engaged proactively with our industrial officers, and there is little evidence they understand what is going on in their region, let alone what to do about it.
The only thing that is clear – sadly – is they are definitely not willing to ask for more resources.
I had a grim experience speaking at a public meeting about overnight staffing at the Kenepuru after-hours medical service, where I heard two of your bosses say things like – “I’ve never been to a community meeting before” and “I haven’t been in this role for long, so I don’t really know.” That’s not good enough.
So what are we doing about it?
I have visited most branches over the course of the year – some many times (“Kia ora Palmy!”) – as we push hard to improve terms and conditions, draw out detail about staffing levels, maintain pressure on your employer to increase FTE, and keep advocating for the clinicians we need to keep you and your patients safe.
We’ve initiated legal proceedings this year to deal with compliance issues of full pay, public holidays, leave transfers, access to remuneration data, and ED shift payments.
Our policy and research team have been crossexamining the swathes of cost savings plans and clinical leadership change proposals that seem to appear every other week.
We heard even before the close of the clinical leadership consultation they knew they’d have to reconfigure it and try again. It was a perfect example of the ill-thought-out, poorly managed, chaotic process that is being repeated ad nauseum across the system.
We must continue to push Health New Zealand to listen to its clinicians, put some decent clinical governance in place and follow the advice you provide!
That brings us to you. Your work matters. Your voice matters. We need you here. We need your work to be safe and sustainable. You get that. I get that. But I am increasingly worried your employer (and your employer’s funder) does not.
It’s a tiring thought at the end of another tough year. But as we prepare for 2025, which I fear will bring more of the same, we need to be ready. If the bargaining parameters put in place by Te Whatu Ora don’t improve, we will have to stand up and fight.
On a personal note, I want to thank those of you who have treated ASMS staff, their whānau, and some of my whānau over the course of the year – 2024 seems to have brought us more than our usual share of injuries, ailments and serious illness. The work you and your colleagues do – and the care you provide, particularly given the challenges of our underfunded system –is first class. Our union – Toi Mata Hauora –will be back in the New Year, fighting as hard as ever to support you and our beleaguered health system.
Ngā mihi manaaki mō Kirihimete me te tau hou!
For your diary, next year’s Annual Conference will be held slightly earlier in the year – 16 and 17 October 2025.
SPEAKING OUT TOGETHER
MATT SHAND, JOURNALIST
ASMS’ 36th Annual Conference focused on the economic constraints currently facing senior medical officers in their work – a problem shared by all health care workers in the public health system. But what can we all do to speak up about the worsening workplace environment?
The 36th ASMS Annual Conference kicked off with a panel discussion about the role of clinicians in a resource-constrained environment.
Health and Disability Commissioner (HDC) Morag McDowell said there have been large increases in complaints made about medical practitioners. One core reason for this is resource constraint.
“We have had an unprecedented increase in the volume of complaints, with complaints rising 25 per cent in one year.
“The complaint profile is also becoming more complex. The HDC considers whether clinicians have taken all reasonable steps in the circumstances, and we include constrained resources as one of those circumstances.”
Asked what doctors should do when patient rights are being breached because of a lack of resources and management has no response, barrister Gaeline Phipps said there was a real need for clinicians to challenge management to ensure clinical voices were heard.
“You need to act,” she said. “You need to make sure you raise it, and you raise it correctly. Raise it at meetings and ensure it is in the minutes. Use ASMS, use the HDC, and if you want things to happen quickly that is where ASMS can act and speak out on behalf of its members.
She said doctors need to avoid Te Whatu Ora’s media people and recognise their rights and provisions within the SECA to speak up.
Stephen Child, a member of the Medical Council of New Zealand, said doctors need to get politically active. “You have to do everything you can.”
Addressing speaking up more generally, psychiatrist Marie Bismark spoke about her experiences during the ASMS strikes and advocating for sexual health and rights of migrants to Australia.
Bismark said clinicians should look at what they could immediately change and what would be the impact if that change occurred as a starting point.
“From there, what strengths can you draw on, what evidence do you have for change, and what can you share with decisions makers to influence that change?” she said. “Doctors need to stand up, and health practitioners should not be complicit through silence.
“Most importantly, know that you can make a difference.”
Bargaining update
The need to speak out collectively is likely to be very important next year, according to ASMS Industrial Director Steve Hurring. As part of a SECA bargaining update to the conference he noted ASMS is already involved in legal action with Te Whatu Ora over non-compliance with the last SECA settlement.
“There has been a breakdown in trust between the two parties,” he said.
Hurring said information is not being offered by Te Whatu Ora about its financial position or explanation of how a $500,000 surplus suddenly turned into a billion-dollar deficit.
The financial conditions have been used to justify an “unacceptably low” offer to SMOs of just 1 per cent.
“We’ve put down a claim for a 12 per cent pay rise,” Hurring said. “Te Whatu Ora has advised us their parameters have been set at 1 per cent, which is a real pay cut.”
Hurring said the employer had rejected superannuation claims and the claim that employees should have definite 30 per cent non-clinical time.
“I think we have been presented with evidence the Government has been seriously misled when it set its Te Whatu Ora budget. We’re living with the consequences of that misinformation.”
ASMS has engaged an economist to dive deeper into Te Whatu Ora’s budget.
“It appears industrial action is inevitable. If we cannot move Te Whatu Ora from its 1 per cent position, industrial action will occur. What that looks like is still up for debate.”
At the conference, members passed a remit declaring that they do not have confidence in the Government to fix the current health crisis.
ASMS also took an indicative vote supporting some form of strike action next year.
A healthy organisation
ASMS remains in a strong financial position.
National Secretary Andrew Ewens said membership had grown 48 per cent in the last decade and currently sits at 6,165.
“The organisation has also returned a surplus for the past year of $1.1 million up from the predicted surplus $973,000.”
The organisation is also well over its reserve cash level of $4.9 million. Members voted to keep membership fees unchanged for 2025
No more money for the health system
Newly appointed Te Whatu Ora National Chief Medical Officer Dame Helen Stokes-Lampard told the conference there was no more money coming to save the health system.
“Once we’re honest [about the financial situation] we can start to be honest about what we need to do to collaborate.
“As leaders we need to call out greed and dishonesty in the system, and no one has the courage to talk about that openly.”
Questions for Stokes-Lampard from the conference floor raised concerns about the normalisation of substandard care, such as keeping patients in corridors.
“We must not normalise the unacceptable,” Stokes-Lampard said. “I’ve seen the system struggle in the UK. It is safer to have patients in corridors then in the backs of ambulances. It is one step less acceptable.
“It is about managing risk in the system, and that is a short-term solution which should never be more than a holding pattern in a crisis situation.
“Accepting what we have now is important. We can still fight for better resources.”
Minister Reti
Minister of Health Shane Reti reiterated his lines about the need to improve workforce and infrastructure and to comply with health targets.
“We do need to work rapidly on this together by challenging the traditional models that no longer serve us and creating a system that delivers modern health care,” he said.
“I reinvigorated health targets. Clear targets are key to improving the performance of the system. They focus resources and attention.
Accountability targets save lives. The targets are focused on things that matter.”
Reti said there is work being undertaken to make it easier for IMGs to move to New Zealand, including fast-tracking doctors from the United Kingdom, Australia and Ireland and providing some exemptions to doctors from Germany and South Africa to make it easier to obtain their medical licence here.
“Cutting the registration pathway from six months down to 50 days, I am very supportive of that,” he said.
Reti says he has been transparent about the financial issues Te Whatu Ora is facing.
“The auditor general was right to highlight the lack of an operating model and performance management framework at Health New Zealand over several years,” he said.
“Whilst incredibly disappointing there are three key activities to return to sustainability: optimise the health workforce, regionalise decision making, and bring the budget back to the front line and standardise.”
He said this would be explained further in the forthcoming workforce plan.
Reti said he also wants to work more closely with the private sector in a bid to reduce waiting times.
But in an interview with Radio NZ following the conference, he clarified he did not see this as a step toward privatisation.
“We can use private providers to increase the delivery of planned care,” he said.
“Similarly, private providers have developed relationships for training publicly funded SMOs and RMOs in private facilities, improving the clinical placement experience.”
ASMS President Katie Ben asked the Minister for his view of ACT Party Leader David Seymour’s
stated desire to privatise more health services. Reti said that is not his “overt policy”.
“You will see us increasing the relationship and outsourcing to the private operators – that is not a step toward privatisation at all, that is not my agenda.”
Life membership awarded
Waitematā anaesthetist Julian Fuller has been awarded life membership of the Association.
Fuller served on the national executive for 13 years, 10 of those years as Vice President. Fuller stood down at the last National Executive election.
“It is an honour to accept this award and join a select group of individuals,” he said. “When I got the call it made me reflect on those members also nominated over the past 35 years.
“I want to pay tribute to the presidents who are often unsung heroes who work a thankless and frustrating position. It has been an honour to serve them as a vice president and help however best I could.
“Highlights include – making roughly 116 round trips to Wellington … and being blocked on Twitter by the previous health minister.”
ABOVE: MINISTER OF HEALTH SHANE RETI. LEFT: ATTENDEES AT ASMS’ 36TH ANNUAL CONFERENCE.
JULIAN FULLER.
THE REAL COST OF BROKEN PROMISES
MATT SHAND, JOURNALIST
The litany of broken promises when it comes to the funding of public health care is costing politicians both in terms of credibility and cash.
Perhaps the public is getting wise to the ongoing practice by governments of either stripe – making announcements and then walking away from delivering on them.
At the last election the National Party promised, if elected, it would deliver 13 new cancer drugs. Unfortunately, that commitment was omitted from their coalition agreement with New Zealand First and ACT and was not listed as a priority in the 100-day plan.
It was also left out of May’s budget. But at that point, as National tried to kick the can a little further, they ran out of road. A ‘big announcement’ was forthcoming.
Alongside the political fallout, clinicians working in cancer treatment have been quick to point out the drugs alone will not make an impact without clinicians to administer them and the extra support staff to book appointments.
Cancer drugs was not the only promise to face a rough road. Promises were made to increase psychiatric registrar places by 13 a year and double the number of clinical psychologist trainees each year over four years. There has been no increase in the budget to fund this.
Similarly, there was a promise to increase the number of medical school placements at Auckland and Otago by 50 doctors each year. May’s budget halved that to 25.
In November, just before ASMS’ Annual Conference, Minister of Health Shane Reti announced that there will be funding for 50 more SMOs to be employed – even though Te Whatu Ora’s most recent figures show we are 1,700 doctors short. On top of that the
announcement lacked any detail about how, when, and from where they would be recruited.
South of…
Perhaps the most prominent example of the problems with promises has been the Dunedin Hospital rebuild.
For nearly 10 years the rebuild has been promised and promised and promised as many times as it has been redesigned, rescoped, rebudgeted, reimagined, reconceptualised then… re-promised again.
In 2022, then Health Minister Andrew Little oversaw the start of the construction of the new facility. While wearing a hard hat and hi-vis vest, he declared, “A promise kept late is still a promise kept.”
That subsequently kept promise refers to the statements made during the 2017 General Election when then opposition leader Jacinda Ardern campaigned in Dunedin on the need for a new hospital. National jumped on board and promised one under a public–private partnership model (though it didn’t cost this out).
Labour, sensing parties muscling into their territory, doubled down and promised a $1.4 billion hospital with construction to start in their first term.
Labour won the election. But no hospital construction started.
Over the next six years, promises continued to mount. A site was purchased (the old Cadbury factory). Assurances were made about the scope and services to be offered. Promises were made
to clinicians about the model of care. Plans were made, then remade and remade again, but for a time, things seemed settled.
Then the so-called ‘value-management’ process started to pare back what would be. Clinicians who were part of the rebuild project said the original design was widely accepted as being adequate and “already including a high degree of efficiency”. This did not stop a lengthy process to see what else could be saved.
But it turns out, breaking promises cost money too. Lots of money. Counting up the costs, it is clear it would have been better to have hit the go button years ago. Instead, due to delays, the cost of construction increases. Building and labour costs continue to rise and consultants up their fees, particularly when government contracts are on offer.
Costs revealed to ASMS under the Official Information Act show that just between the months of July and December in 2022 $1.9 million was spent on the value management project alone. A fuller picture of the costs has yet to be released by Te Whatu Ora.
Meeting minutes from the value management process show there was concern “redesign will result in costs and time” and it is not clear if “value management recommendations are clinically endorsed”.
Meanwhile, another election occurred. It was, again, full of promises about Dunedin Hospital. Labour said during the 2023 election campaign that there would be a reduction in the scope of the new hospital. National came out firing, saying it would put back everything that was being proposed for the cutting room floor.
National won. Their promise was forgotten almost immediately.
In May 2024 a report was produced at the Government’s request by the former Chief Executive of Health Infrastructure New South Wales, Robert Rust, suggesting the Dunedin hospital could not be built to current specifications within the current budget.
The report showed the indicative business case completed in July 2017 allowed for a total cost of $1.28 billion to $1.43 billion.
This increased in April 2023 to $1.58 billion and in March 2024 to $1.88 billion.
The report itself cost $267,903 to produce –or $3,720 per page.
In 2023 the Government had committed to spending $1.9 billion on the hospital but, even then, there were talks of “scaling it down” and potentially retrofitting the old hospital.
In September 2024 Infrastructure Minister Chris Bishop and Health Minister Dr Shane Reti visited the construction site and said the hospital construction could not proceed as planned due to the costs that were now expected to reach upwards of $3 billion instead of $1.4 billion.
As politicians argued over who broke what promise first, 35,000 people took to the streets of Dunedin to protest against the cuts.
A promise made
No matter who broke what promise, it appears that it is members of the public who will feel the pain – until politicians are held to greater account over their announcements.
Ironically, one of the few promises about health that has been kept is the scrapping of smokefree legislation. In the end, that is likely to see more people needing to visit the hospitals – hospitals that may or may not be built.
In the end, broken promises come at the cost of the health system’s credibility. The chronic underfunding, widespread SMO shortages and increasing unmet need have not happened because promises were kept.
Looking again at Dunedin Hospital, it will need to have 513 beds by 2043 in order to keep up with population growth. As it stands, it won’t. Instead, we can expect more promises and announcements to fix the problems created by the initial announcements and broken promises.
Following the marches and public campaigning to save the hospital in Dunedin, Prime Minister Christoper Luxon spoke at a public event. Spying a young person with a ‘Save Our Hospital’ badge on he said, “Don’t you worry, we are going to build you a kick-arse hospital.”
In response the young man curtly said, “You better.”
[Dunedin Hospital] will need to have 513 beds by 2043 in order to keep up with population growth. As it stands, it won’t.”
ABOVE: “CLIFF” THE AMBULANCE HAS BEEN GATHERING SUPPORT FOR THE CAMPAIGN TO SAVE DUNEDIN HOSPITAL.
RIGHT: THE COMMUNITY HAS RALLIED AGAINST THE PROPOSED CHANGES TO THE NEW HOSPITAL BUILD.
CALLING THE POLICE
MATT SHAND, JOURNALIST
Mental health clinicians are discussing wearing stab-proof vests in the wake of the NZ Police decision to pull out of mental health community assessments.
Earlier this year former Police Commissioner Andrew Coster announced police were pulling back from community mental health callouts because it was taking more than half a million hours of police time every year.
The rollout of this decision will occur in phases. Police are already pulling back from conducting transportation of mental health patients and attending mental health facilities.
From January 2025 this will extend to a hard cap on the amount of time police will remain at a medical facility after transporting a person there, initially to under 60 minutes and eventually reducing to 15 minutes.
Psychiatrist and ASMS Wellington branch president Alain Marcuse says the safety of staff has become a big concern as police have been less present for mental health call outs.
“There is a big gap at the moment,” he says.
“We are talking about ways to mitigate the risk, such as wearing stab-proof vests and stuff like that.”
Marcuse says there have been significant teething issues implementing the NZ Police decision, which clinicians are still working
through and which are having an impact on patient outcomes.
“It has a big impact on families because they suffer more,” he says.
“They are not getting the help they are asking for and the help in the time that they need it.
“Sometimes they may call the police because a family member is agitated and are told to call a mental health facility. Then we hear the family member is smashing up the place and so we have to refer them back to police. It all takes time.”
The reduced capacity for transferring patients is also a concern.
“Staff are at risk of being exposed to more danger,” he says.
“We can be transporting someone who is agitated a long distance, say from Wairarapa to Wellington, and they are very unwell. It can be dangerous.”
A key issue is the role and rights of security staff who will have to fill in the gaps police have left.
“There is likely a legal discussion about what powers security staff have in their role of
protecting people experiencing mental health issues,” Marcuse says.
Law enforcement
NZ Police declined to be interviewed for this story, but Health Partnership Manager Inspector Matthew Morris provided a written statement.
“We can assure the public that Police will always attend when there is an immediate risk to life or safety, this includes health sector requests for assistance,” he says.
“Both NZ Police and Health NZ care about the safety of health professionals and recognise the important mahi they do for our communities. It’s important they feel safe, which is why we have committed to phasing in these changes.”
NZ Police says it is currently at phase one of its retreat from mental health callouts, which includes the following changes.
• Police will carry out voluntary handovers at emergency departments for persons in mental distress who wish to undertake a mental health assessment. These people will be handed to ED staff, with police departing shortly afterwards.
– SLYVIA BOYS
There needs to be a discussion about what powers people have, both security officers and police, particularly as mental health callouts continue to rise.”
• Police will require a greater threshold to be involved in mental health transportations.
• Police have increased the threshold to attend mental health facilities to reduce unnecessary police presence on health premises. They require more risk planning from mental health staff before attending.
Morris says NZ Police is meeting with Health NZ and the Ministry of Health to discuss and plan for the changes going forward.
“By reducing Police involvement in mental health events, we will reduce the unnecessary use of restrictive and coercive practices, reduce unnecessary trauma for distressed people whilst also enabling Police more time to deploy to the work that only Police can do and the community expects us to do.”
ASMS Vice President and Auckland emergency medicine doctor Sylvia Boys says there is a grey area in relation to the powers of security guards in the emergency departments.
“After someone has been sectioned then they can act under the Public Safety Act,” she says.
“There needs to be a discussion about what powers people have, both security officers and police, particularly as mental health callouts continue to rise.”
Boys says the current shortages of psychologists and psychiatrists, coupled with increasing violence, are having a major impact on emergency departments.
“A major part of the problem is we have, in general, more aggressive behaviour occurring in society at the moment and we are dealing with that in the emergency departments,” she says.
“Combined with the underlying understaffing issues in mental health to begin with, we have a huge demand on emergency departments to care for mentally ill patients for long periods of times.
“When we measure how long someone has been in the emergency department, the clock stops ticking at 100 hours. I have seen mental health patients waiting more than four days to get through. They take up space, wander around, make the environment more challenging. It is not conducive to the patients’ health.”
Boys says the results are a reliance on security and restraints – physical and chemical – to keep patients safe. That does not provide a good outcome.
“Another area of concern is the rising number of meth and meth-affected people who are mistaken as a mental health case,” Boys says.
“Some people present as a mental health case but it becomes very clear they are meth-affected and their behaviour changes as they sober up.
“I would say two thirds of our cases are drug and alcohol related. It would be good to have a means to test people remotely before they are brought in as a mental health patient.
“I think this needs to form part of the discussion going forward.”
LEFT: ALAIN MARCUSE. RIGHT: SYLVIA BOYS.
PHONING IT IN?
MATT SHAND, JOURNALIST
The rollout of after-hours telehealth on the West Coast has met with plenty of resistance, from criticism of the clinical consultation to public protest. But telehealth has also already become a go-to method to try meeting health need with less resource. In the first of three stories The Specialist looks at what happened on the West Coast and why.
Dialling an ambulance from the closed hospital carpark was not Kate’s plan. Her husband was in the car suffering from heart palpitations and the closest emergency room was 1.5 hours away by road.
“He had come home from work about 6 pm and said he really didn’t feel well,” she says. “I’m not sure why I didn’t call the ambulance right away, but I thought we’d better get down to Buller Hospital. When we got there, it was closed. No one answered the buzzer.”
With no other options, Kate called emergency services from the carpark of the hospital. The sole ambulance covering Buller arrived shortly after and began the 90-minute trip along the snaking coastal road to Grey Hospital.
“The story had a happy ending for us, but it could just as easily not have,” Kate says. “They will find someone dead on their doorstep soon enough unless things change.”
Since it opened last year, due to staffing shortages and other factors the $21 million hospital in Buller has been closed more than 25 days and 30 nights. The main reason has been the lack of staff, made worse by a lack of funding to attract and retain staff.
The closures included the hospital’s acute stabilisation unit, which has, on occasion, been out of action for consecutive days at a time.
This has been further compounded by the decision of the primary health organisation, West Coast Health, to stop providing after-hours care because it was proving “cost prohibitive” for the private practices involved.
The result? After 5 pm and on the weekend Buller residents (and many others on the West Coast) could choose between phoning Healthline or the town ambulance or emergency helicopter and driving 100 kilometres to Grey Hospital for care.
GP practices, already struggling to cope with insufficient rural capitation rates and low doctor
numbers, did not feel able to provide after-hours care, so West Coast Health turned to telehealth, a solution that is fast becoming the thing to do in rural communities.
“The GP practices were financially failing,” West Coast Health general manager Caro Findlay says. “We got together a group of practice owners and asked them what the longest time frame would be they could keep the clinics open. They said October, which gave us a firm date as to when we needed to have a replacement system operating.”
When the after-hours clinics did run, they were only open for two hours, and responsibility was shared between several practices. This raises a question about how tight the private practice balance sheets were.
Findlay says the level of capitation rates has not kept up with the complex needs of remote West Coast practices and the cost of delivering afterhours care.
“These guys operate on the finest of margins,” says Findlay. “Some of them lose money and actively put their own salaries back into the business.
“So, to open a weekend clinic, where you are paying penal rates, you have a receptionist, a nurse, a doctor and all that stuff going on, was a significant cost to the baseline.”
Emails released under the Official Information Act reveal discussions about using telehealth on the West Coast began in July with a lot of pressure on internal staff to troubleshoot the problems telehealth would cause in rapid succession.
“When we talk about the change team it really was just me and Clinical Director Emma Boddington. We had to manage all the stakeholders over that three-month period and get it going,” says Findlay.
Findlay sees the new telehealth system as a replacement. “We replaced the weekend clinic, which was open for two hours, to now 24-hour
cover over the weekend and after 5 pm and before 8 am. And people can call in from home. It is fantastic.”
Ka Ora, which holds the telehealth contract, is paid to deliver the service, but we do not know how much. At the same time, there has been no reduction in the funding sent to the GPs by the primary health organisation.
Under Ka Ora’s model, patients must pay ahead of receiving treatment via the phone line.
Findlay says the cost to the community of not replacing after-hours clinics with telehealth services would have been severe.
“Money and workforce were failing fast,” she says.
“If a practice was to close its doors over the weekend clinics it would have an enormous impact on the workforce in terms of stability and even being able to maintain the acute stabilisation unit. Things were deteriorating rapidly.
“In-person care with infinite availability is the dream, but we have to be realistic here. The cost would be exorbitant.”
It helps that the cost of operating the after-hours service has been moved to another organisation.
“It [capitation] has never been ring fenced,” Findlay says.
“We’ve never had to ask practices to demonstrate how they are using funding to fund after-hours care. It is clear that successive governments have underfunded primary care and we are all dealing with the impact of that, and trying to manage things until somebody sees the light and decides to fund it properly.
“Te Whatu Ora seems to love hospitals. Primary care, particularly rural primary care, is the poor cousin. The capitation formula is out of date and work streams are never ending. At some point somebody is going to have to invest in a solution, but until then, all we can do is hold the line for the community.”
We got together a group of practice owners and asked them what the longest time frame would be they could keep the clinics open. They said October.”
– CHIEF EXECUTIVE WEST COAST HEALTH CARO FINDLAY
CROSSED LINES
MATT SHAND, JOURNALIST
In the second part of our look at the implementation of telehealth on the West Coast, The Specialist talks to the people providing health care on the West Coast, whether in person or over the phone.
I think the public versus private debate does not matter. It is about how do we get care to the right people at the right time.”
Telehealth services on the West Coast are currently being provided by two related privately owned companies under contract to Te Whatu Ora – Ka Ora and its subsidiary Emergency Consult.
Both of these companies are operating in Northland already and have expanded to include the West Coast.
Since 1 October when someone presents to the acute stabilisation unit in Westport they are met by a nurse who will offer initial triage then take the patient to a computer screen where a Fellow of the Australasian College of Emergency Medicine (FACEM) can make an additional assessment via video conferencing.
There should still be an on-call physically present doctor available if the video FACEM deems direct involvement is necessary.
Chief Executive Officer of Emergency Consult Jenni Falconer says they started Emergency Consult because there was a need for more after-hours medicine and the public health system was not delivering it.
“Face-to-face consultation is the gold standard,” Falconer says. “The reason we set this company up was to answer the question ‘How we can provide support to areas of New Zealand that do not have access to in-person care?’
“We saw that type of service was not going to exist anytime soon, so we set out to fix that. I think the public versus private debate does
not matter. It is about how do we get care to the right people at the right time.”
She says using a hybrid of telehealth and in-person care can help retain the workforce by reducing burnout and fatigue for on-call doctors by taking away non-critical patient loads.
“If we can keep a doctor working on the West Coast a little longer because they are not being woken up every single night and the work–life balance is restored, then that is a huge saving to the community and the Government,” she says.
A lifeline
Emergency Consult Clinical Director John Bonning says telehealth services are becoming significant parts of the health system and they help support rural communities where local doctors are not always available.
“Telehealth is not second-class care,” he says. “A rural doctor cannot work 24/7.
“Telehealth is very good at supporting the significant majority of the people we see. We see ourselves as supporting communities and supporting local doctors.
“We need local doctors, but the vast majority of after-hours care can be handled by us without the need for on-call doctors to attend.
“Most of the time our expertise is used in the process of decision making. We need a mind to say, ‘This is chest pain, and they need to go to
the big hospital now’ or ‘We need to get someone to see them on site now’.”
Bonning says telehealth services can lead to big savings to the taxpayer and government if implemented correctly. He says Australian services receive state funding for this reason and some see more than 900 patients a day.
“We feel telehealth is excellent value for money for the regions and for keeping people out of hospital who do not need to attend,” he says.
“The private–public partnership is a fine line to walk. I would do this work if it was publicly funded. Yes, it is costing the taxpayer. But it would already cost the taxpayer [if the patient presented to hospital]. I do think it is something that should be incorporated into the public health system as it is to some degree in Australia.
“None of us are getting particularly rich out of providing this at the expense of the taxpayer.
“I do think that telehealth has to be part of the way forward. I think the model works very well.”
One particular advantage Bonning thinks telehealth has is that it can make use of a global network of doctors, provided they have a New Zealand practising certificate.
“We are able to utilise doctors from the United Kingdom and the United States, for example, who can cover our night shift but during their daytime,” he says.
In its first month of operation, the West Coast Emergency Consult saw 51 patients and was able to discharge or resolve 81 per cent of presentations without needing intervention from the on-call doctor.
Of those, 2 per cent (1 patient) required an ambulance transfer to Grey Hospital.
“It is about decompressing the health system,” Bonning says.
“We can provide support for the people of Westport so they can have access to good care. Everyone thinks their chest pain is a heart attack, and their abdominal pain might be cancer, but we can tell pretty accurately whether it is or isn’t and whether they need access to care right now and whether to get the ambulances called in.”
Measuring up
The ambulances that are called will invariably end up at Grey Hospital. A major concern with telehealth systems is that people will try to bypass the system and dial 111 or attend the emergency department for non-emergency cases. The fear is this will just place additional strain on already short-staffed hospital facilities.
Interim Group Director Operations for Te Tai o Poutini West Coast district of Health New Zealand Phillip Wheble says presentation data is being closely monitored in the wake of the telehealth rollout.
“At the moment, we have not seen the increase,” he says. (Te Whatu Ora was not able to provide specific figures at the time of writing.)
“In that regard it has been a smooth transition. It is still early days, but we have been very clear that we want regular monitoring of the impact on hospital presentations.
“If we start seeing some data that is showing we have an issue then we would want to respond to that. It is important to understand that we want to be providing after-hours care to the community, but we all need to look at how to best provide those services to the community in a sustainable way.
“This requires a change in the way rural hospitals are run and how after-hours services are tailored. The closure of the after-hours services shows how tight the situation is in rural communities.
“We have a workforce sustainability issue,” Wheble says.
“If you take an urban model and plug it into a rural setting you will quickly come down to small groups of people trying to cover a 24/7 roster.
“That is not sustainable. You need to look at how you can provide a more sustainable work environment. One approach is the rural generalist model, which has seen a big improvement to services in the West Coast.
“With this model we have relief teams of about 18 that can provide cover for people away on leave and create a more stable workforce.
“When you look at the acute stabilisation unit, we had 2.5 people trying to cover the service, and it is just not going to happen. Telehealth allows us to use a broader model of care. Clustering of services and teams enables a larger number of people to create robustness. A roster says you need so many FTE but, in rural areas, it’s about the number of people not the FTE count.
“Emergency Consult services have eased the burden for the on-call doctor to make it, at least, bearable. The on-call duty is still required but we are called in much, much less now, which allows us to get some rest, which we often couldn’t at all.”
Laurenson says on-call locums brought in to cover the facility, prior to Emergency Consult, would often become frustrated with the volume of patients and many would vow never to return, at any price.
“We are dealing with a diverse population here on the West Coast with very low health literacy,” he says.
“As an SMO you know that you will be woken up to help people in need and treat patients. But it is good to be woken up to treat patients that really need it. Not someone who has had a hard poo and thinks they are chronically constipated.”
Laurenson says telehealth services allow a level of decision making to occur before pulling in the on-call doctor. “A lot of medicine is about having the authority to make a decision, and this service allows that to occur,” he says.
“That decision may be to wake up the on-call or that some pain medicine is all that is required.”
Laurenson says as much as face-to-face consultations should be the standard, current funding levels and staffing shortages mean it is simply out of reach for rural regions with fewer doctors.
“It is not practical to provide all the medical care needs for an area of this size and this population,” he says.
We are all feeling very tired and disillusioned with the system, and not being involved in the critical decision making for this region makes it worse.”
– CERI HUTCHINSON
“It means you do not always have to bring a specialist to the West Coast or make people travel for hours to get to an appointment. Telehealth can be a real enabler for rural communities. But we have to understand how it will work with existing services.
“If it means better access to primary care, because that is essential in rural communities, then it will result in less people coming through the secondary care system.”
A line on burnout
West Coast SMO Andrew Laurenson says the workload has become slightly more bearable since Emergency Consult was introduced in Westport.
“When I was on call at the acute stabilisation unit it was a really mixed bag,” he says.
“Sometimes I would have used up all my blood on the first night trying to resuscitate someone and being called in every hour or so, always being asked to treat just one more patient.
“There is a level of acceptance from the community that there are less good health outcomes by nature of the remote location.
“We also have to ask, where is the best place to have surgeries? Should we remove appendixes in rural hospitals, or transfer to metropolitan ones which are more robustly established?
“Telehealth is another layer in the ongoing patchwork of health care. There are always going to be holes, but it can help plug some of them.”
A line of questioning
But the speed in which telehealth services have been rolled out to the West Coast, as a reaction to GP services possibly closing, has some clinicians concerned about unintended consequences.
Ceri Hutchinson works at Grey Hospital and says there has been a lack of consultation with clinicians and the public.
“Telehealth has been implemented here without due process,” Hutchinson says.
“Emergency Consult came along first. There was a consultation that we were invited to go along to and ask questions, which we did, but we did not get any answers from that. We found the answers we did get to be arrogant and akin to ‘Well it worked in Northland, so it should work here’.”
Hutchinson was part of a team that was meant to be simulating the Emergency Consult environment ahead of its implementation but, she says, this never happened.
“We were meant to test the Emergency Consult telehealth process by acting as patients who required different degrees of intervention and see if the system worked for them. This did not occur.”
She says not being able to test the system beforehand was demoralising.
“We are all feeling very tired and disillusioned with the system, and not being involved in the critical decision making for this region makes it worse,” she says.
“There appears to be too much onus on who controls what is happening rather than the outcome.
“This will be worse when we lose our CMO as part of the Te Whatu Ora cost-cutting measures and we lose more ability to advocate. It looks like we are having services cut down left, right and centre, with telehealth popping up as a small solution.”
With Ka Ora, Hutchinson says there was even less consultation.
“There was no meaningful consultation [with SMOs] about it,” she said. “When there was, we felt they had already made their decision, and we reminded them they had an obligation to consult with us. So they sort of started one retrospectively.
“We were getting calls from the community wondering ‘What is this phone thing? Does this mean the hospital is closed?’ The whole thing has been driven by GP clinics not wanting to do their on-calls anymore. It’s all about money.
“The GPs did not want patients presenting to us at the ED because then they have to pay clawbacks, pay the hospital money for us seeing their patients. So, it’s all a financial mess and tied to money.”
The bottom line
Hutchinson says she understands the challenges for rural medicine well and that it is not possible, in the current funding model, to have surplus clinicians available. However, she says it is good to try and she is concerned an over-reliance on telehealth could reduce rural health’s ability to upskill and train where needed.
“If you over-staffed this hospital, there would be periods of clinician downtime,” she says.
“But that is where a lot of good work can happen. That is when we can improve the systems, create training pathways and upskill people. We can make a strong rural pathway if we have time.”
Hutchinson says use of telehealth is making the on-call more bearable, but it does not remove the need to have an on-call doctor. The problem could be just as easily solved by recruiting and retaining another on-call doctor to allow adequate recovery time.
“It [telehealth] just means you are called in less, which is a good thing. I’ve done that shift and it is terrible. You were always getting up and down all night, usually for things like pain relief.”
She says rural solutions need to be developed in rural settings and should be bespoke to the
region they are developed in. Adequate staffing would allow innovation to happen.
“We need rural, clinical stakeholders involved in the decision making,” she says.
“Not just have stuff foisted upon us that has, maybe, worked somewhere else. I am not against telehealth, but I think it needs to be implemented in a way that aligns with our current values and fits into the rural system.
“What worries me is that we are already short on SMOs and emergency medicine specialists, but telehealth is going to incentivise people to go and work for private rather than in our emergency departments.”
She also laments the way telehealth unintentionally facilitates the erosion of face-to-face services in the community.
“It is unfair out here,” she says. “Westport used to have a hospital. Now it is an ‘integrated family health centre’. Basically, it has been downgraded. I find it offensive being a New Zealand rural health generalist, because Westport Hospital is one of the ones I trained in.
“I think it was a fantastic resource. If we are trying to create a New Zealand pipeline of rural doctors here, we actually need small, rural hospitals, like Westport used to be. It is where doctors can work with an SMO and grow their skills. Allow doctors to learn how to make independent decisions and develop the decision making you need when you do not have the resources of a metropolitan hospital.
“We’ve missed a trick here. Replaced much of that service with a phone line – and it is not fair to take the locals’ hospital away from them.”
None of us are getting particularly rich out of providing this at the expense of the taxpayer.”
– JOHN BONNING
ABOVE: EMERGENCY CONSULT CLINICAL DIRECTOR JOHN BONNING. RIGHT: WEST COAST DOCTOR CERI HUTCHINSON.
A BAD CALL
MATT SHAND, JOURNALIST
The third part of our report on the introduction of after-hours telehealth on the West Coast looks at the rollout itself and asks whose interests decision makers really had in mind.
Ask anyone in Westport what the large building on Cobden Street is and they will say, ‘It’s the hospital.’ The notion that it is to be referred to as the ‘Integrated Family Health Centre’ is lost on the public. For residents of Buller, it has, and likely always will be, the hospital.
While the primary health organisations and Te Whatu Ora wish for people to stop calling it a hospital and use the new term, the community has made their position clear. Both in how they refer to it and what they expect when they turn up there.
This is part of why pulling away the in-person after-hours services has generated such a strong public backlash.
In September about one-third of the population of Buller marched to protest the changes and call for greater health investment in rural areas.
A declaration to fix the broken health system was started and has been touring the West Coast, and rest of the South Island, gathering more signatures.
Buller Health Action Group leader Anita HalsallQuinlan says the community calls it a hospital because they do not want it to close.
“Losing it would mean losing the community,” she says. “Many are afraid and are questioning if they can stay here.”
Halsall-Quinlan says there are more and more stories of people let down by the telehealth services spreading around the community.
“One lady rang up with high blood pressure, waited a few minutes, never got heard then gave up and called an ambulance,” she said.
“The problem is the ambulance costs $100 and there are not many in the region. We cannot put more pressure on this service. The ambulance drivers are becoming glorified taxi drivers taking
people back and forth from Greymouth. They are losing volunteers over it.”
Halsall-Quinlan says there is a lot of confusion within the community and patients are having worse health outcomes as a result.
Jacqueline Kirkwood is an 84-year-old woman who ran afoul of health services. She had attended Buller Hospital but was discharged without a diagnosis.
“I started vomiting at 5 pm and that continued until about 10 pm,” she says. With no after-hours facility open near her, she called Healthline.
“They ended up dispatching an ambulance. It was a 2.5-hour trip to Greymouth Hospital and they had to dispatch the ambulance from there so it was a 5-hour trip for them.
“I remember laying on the ground wishing they would get there sooner. It was not their fault of course. It was about 3 am by the time we got to the hospital.
“It has shaken me [the lack of health care availability]. Maybe it is time to go into a home. I cannot leave the West Coast. I’ve been here for 84 years.”
Other residents have reported a fear that they will ‘age out’ of their communities – effectively reaching an age where they have to leave in order to get the life-preserving care they need.
Nic Meadowcroft has a rare condition that requires regular infusions. Currently she has to drive from Buller to Greymouth for treatment.
“I’ve done that for the last five years,” she said.
“It is my life.”
She tried to have her infusions done at Buller’s Integrated Family Health Centre but says that experience was not good.
TE NIKAU, GREY HOSPITAL IN GREYMOUTH.
The change is still early days, but we think it has gone extraordinarily well.”
– WEST COST HEALTH CHIEF EXECUTIVE CARO FINDALY.
“They lack the proper facilities, and I have to sit there getting my infusion in what is essentially a waiting room,” she says.
“It’s for an auto-immune disease, so it is not a good place for me to be. I feel very vulnerable.”
This, coupled with a lack of doctors to administer treatment, and issues getting the medicine couriered out in the first instance, has led to her abandoning treatment at Westport.
“I went once and just had to drive on,” she said. “I just could not bring myself to go in there. Why is it so hard to have a procedure done at a local health clinic?
“The last three times I tried to have my treatment done locally it was delayed. That causes me a lot of issues. This is my life. I need this treatment forever. What happens to regions when people cannot get health care in their own towns?”
Residents rally against telehealth
In September, 1,500 residents of Buller marched through the streets to take a stand on the dire lack of health care services in their community.
More than 3,000 people from Buller signed a declaration calling on the government to increase funding of health care in the region to ensure their communities have access to equitable care.
Mayor of Buller Jamie Cleine was the first person to sign the declaration. Despite doing so, he says there has not been much concern raised to him directly about health services.
“Remarkably not,” he says.
“I have had a couple of examples of people that had difficulty navigating the system, but I would say generally people do not understand what is and isn’t available, which is a communications issue [for the PHO].”
Concerns that have been raised with Cleine are about the amount of community consultation done regarding the way health services are provided.
“Our household income is about 30 per cent lower than the national average,” he says.
“Internet and phone access is another thing and about a third of our population are over 65. There are huge risks that have to be faced, and funding of health needs to be a national issue. You cannot use one model for all health care systems.
Cleine says he wants to see the declaration change the way rural health is funded in New Zealand.
“For instance, when you start looking at the geography of the West Coast, it covers the same distance as Wellington to Auckland,” he says.
“For much of the time the only 24-hour care we have is in Greymouth, and that is like asking
someone in Wellington to drive to Rotorua for health care. It would not be acceptable in other places.”
“It puts a lot of pressure on St John, and they are always struggling to staff shifts. It would not be exaggerating to say the helicopter would be here every day making a transfer. I cannot imagine what that is costing.”
Buller District Council recognises the need to keep doctors, nurses and primary care staff in town and, in 2020 via the Buller Health Trust, decided to purchase a GP clinic after hearing it would close.
Kawatiri Health sees more than 2,400 patients per year. Chief Executive Pauline Ansley says telehealth services have been trialled at the facility but were deemed to be ineffective for the most part and not offered by their clinic.
“In our experience, many patients present to telehealth with acute conditions requiring inperson consultations,” she says.
“This led to inefficiencies and increased operational costs as well as impacting on funding.”
She says the Ka Ora system is trying to address the ongoing challenges rural communities face around workforce pressures, but their clinic is focusing on its service delivery during its opening hours only.
“We want to highlight that Ka Ora after-hours service will continue to provide access to health care 24/7 and ensure the community has the support it needs,” she says.
“Since the closure of Buller Hospital’s after-hours service we have not received complaints from our enrolled patients, indicating their continued trust in our care.”
Another of Mayor Cleine’s concerns is that primary care can only go so far. Eventually people will need help and rely on the public health system. He does not want to see financial barriers prevent people from seeking care.
“It is 100 bucks to get an ambulance, and $50 for an after-hours consult. So, people will wait. They wait till Monday or till things worsen. Maybe then they can see the doctor and maybe you have a worse health outcome because of that.
“It is difficult. It is not a management issue, it is a funding issue. In the current climate Ka Ora is going to achieve more for people than not having Ka Ora, because we do not have the staff or resources.
“We cannot keep pretending that we could have kept the weekend clinics open because that means the clinics had to close on Monday or Tuesday because that doctor still needs a day off.”
Cleine does say the consultation with the community has been lacklustre.
“Yeah, the whole communications thing was dropped – what can people expect, how is it going to work – has been missing.
“There have been some teething issues with patients that have presented to the Ka Ora system and ended up having issues with tests and things not being followed. So it falls to the regular GP. The handover of care bit does not seem to be happening, so the processing system could be better sorted out.”
Redactions speak to rushed telehealth rollout
Documents released under the Official Information Act reveal there was a rush to implement telehealth services for the region, which could explain the community misunderstandings.
While efforts were made by Caro Findlay and West Coast Health to deliver pamphlets and leaflets, it is not difficult to find residents struggling to understand the changeover.
ASMS was able to obtain an unredacted copy of the Official Information Act request that outlines how difficult the changeover was and the efforts made to keep information from reaching the public and media outlets.
The main thing West Coast Health wanted to keep out of the media was the cost to the customer to
use the service, which was to be set at $50 per consultation – higher than most GPs in the region.
In July, Findlay wrote to staffers about the need to keep the fee out of media enquiries, but this was redacted from the publicly released information.
“We do not want media enquiries about this service charge ahead of implementation and there are also staff who have not been consulted with; as well as primary stakeholders like ARCs (aged residential care),” Findlay wrote.
There was also a commitment to prevent leaks and avoid media comments until September.
“I am trying to avoid public comment at the moment, until we have nailed the clinical risk components. It may be hopeful to think we can get through to September 2 without local media enquiries, so I will finalise a holding statement tomorrow,” she further wrote.
“I am going to be absolutely ruthless with document control. I cannot have hundreds of versions to manage.”
Another suppressed aspect was the additional funding to be provided to Grey Hospital to allow for any increased presentations following the introduction of the Emergency Consult telehealth service – $85,000 for a 3- to 4-month period. If continued, that would equate to $340,000 a year.
TOP AND LEFT: BULLER MARCH FOR OUR HEALTH.
BOTTOM RIGHT: BULLER DISTRICT COUNCIL MAYOR JAMIE CLEINE.
That is like asking someone in Wellington to drive to Rotorua for health care. It would not be acceptable in other places.”
– BULLER DISTRICT COUNCIL MAYOR JAMIE CLEINE
There were also concerns about meeting an implementation date for telehealth services of 1 October, and that Te Whatu Ora clinical staff were suffering from “high volume of work load”.
Documents say Te Whatu Ora staff needed to be supported in order to understand the change and “not push back”. Unfortunately, this appears to have translated into avoiding engagement with clinicians.
Te Whatu Ora regional practice manager Andrew Goodger wrote on 4 July that there was a desire to fund some extra backup to Emergency Consult at Grey Hospital and Westport. “Thinking it will be $150k for 3 months for the two sites. This is partly to mollify existing staff with the change … Phil Wheble is also very nervous about if the shift will increase volume dramatically in the short term.”
There was also discussion of cancelling other public health contracts, such as with Whakarongorau Aotearoa, to release funds.
“I am not super keen on this,” writes Goodger, “but I was thinking if we cancel the Whakarongorau contract, that is $50k in this financial year we could offer.”
The redacted information also reveals five clinical risks West Coast Health was aware of but did not want to share with the public. Delayed access to pharmacy services, mainly due to the opening hours of pharmacies in the region, was rated a medium risk. Rapid deterioration of patients was given an extremely high risk, given the shortage of access to medications should these be needed. Aged care residents being excluded from Ka Ora cover was rated a medium risk, with another telehealth service – Third Age Telehealth –to be used as a potential mitigating factor.
A lack of public confidence in the health system was also rated a medium risk but was to be mitigated simply by “excellent provision of service by Ka Ora”.
Lastly, the lack of phone and internet services was regarded as an extreme risk that could only be mitigated by creating an 0800 number (which does not help those without phones) and by ensuring the community members knew where the closest phone was.
The documents also reveal National MP for West Coast Tasman Maureen Pugh was provided with a draft implementation plan for the telehealth rollout around 31 July. Findlay wrote to staff saying Pugh was supportive of the service charge and had “offered to take my final draft of the comms team and put it in front of Minister Reti’s health comms team.
“That will allow them to prepare draft comment, if required, but they are also going to give me some feedback on the messaging – from the perspective of all stakeholders wanting the public to retain confidence in the health system.
“I will, of course, retain the final sign off on the comms and will send final versions … again for feedback from Commissioning before anything is issued.”
Curtailed consultation
On 5 August one of Te Whatu Ora’s HR staff wrote about the impact of the proposal regarding the loss of the weekend GP clinics. It was revealed the clerical staff get paid for the hours they work, nurses get double time for working the weekend, and doctors are paid by exception or locum rates where applicable.
There was discussion of a “buy out” of staff time for those employees who would no longer be paid for running the after-hours clinic.
“I am assuming that the unions (nurses and PSA) will argue we are depriving their members of making extra money – given they have gone over and above to give up weekends to support the service. The usual strategy in these situations
is to do a buy-out. The traditional calculation for this is to review the earnings over the past two years and pay a years’ worth as a buyout.
“Not written down anywhere but common practice in these situations with unions as a clean calculation. If unions raise this issue, I will get the calculation firmed up by payroll, so we know the actual costs involved. Good news is that we will also have some ongoing savings – especially in the doctor’s locum costs.”
On 12 August there was an email out to some unions about changes to the after-hours care and the implementation of Ka Ora/telehealth services.
ASMS was sent the document on 14 August after sending a charged email to Te Whatu Ora about a potential breach of Clause 43 in the ASMS–Te Whatu Ora SECA and the failure to consult and seek the endorsement of ASMS before undertaking any review that might impact on the delivery or quality of clinical services.
On 20 August Te Whatu Ora noted the impact of poor change management processes. “The Ops manager hadn’t raised the model of change with the ED team and the primary care team already knew about it. … The ED docs pulled in ASMS. So now we have union involvement that may escalate to media.”
Despite this, the change team was confident they could continue as needed and wanted to avoid having a “bunch of upset clinicians”.
One clinician, a nurse, wrote to West Coast Health to say that while she hopes the changeover works, she had some concerns over the volumes of patients.
“You have said Te Whatu Ora’s position is that the removal of these clinics is not a substantial change in our terms and conditions of employment because there is no change to your base hours of work and there has been no requirement by Te Whatu Ora for these sessions to be worked. This is incorrect.”
“There has been expectation of the past 5 plus years that I come in for weekend clinics. These clinic dates have been booked up to six weeks in advance and I have often had to change weekend arrangements to accommodate working the clinics.
“When I tried to stop doing the clinics because I was unwell it became a very big problem and I had to agree to continue doing them. So, I do not think you can say there has been no requirement for us to work.”
Talking with the community
Findlay says she stands by the consultation undertaken with the community.
“I think the time and effort we put into planning and consultation with the clinicians and the practices running the in-person service before we moved to the Ka Ora model was really useful. And then the time we spent into communicating with the community the changes as well,” she says.
“We knew we had to get this all done by October 1. It was a hard deadline. It would not have been our preference to do it within that timeline, but money and workforce were failing and it was either act now or a practice might close its doors. The impact of that would be enormous.
“The change is still early days,” says Findlay, “but we think it has gone extraordinarily well.”
From 1 to 27 October Ka Ora received 203 unique calls from the community. The number of calls
resulting in ambulance callouts increased from 2 in the first week to 7 in the last week.
Over the same period presentations at Te Nīkau | Grey Hospital & Health Centre ED increased from 47 over a weekend to 55. Te Whatu Ora categorised this as “not a discernible rise” but will continue to monitor the number over the next five months.
“Thinking about the implications of clinical change, let alone asking our members what they think before they do it, often seems beyond Te Whatu Ora managers,” says ASMS Executive Director Sarah Dalton.
“It just isn’t good enough. Talking with staff about change is not rocket science. But Te Whatu Ora seems to see it as an idea from another planet.”
“The Commissioner [of Te Whatu Ora] keeps talking about the importance of clinical leadership and its value in ensuring effective decision making within the organisation.”
“Well, if he is serious, it’s time to pony up and fix the way his organisation is running.”
“I was at the rally in Westport and that community sent a really strong message – a message provincial communities across the motu would tautoko – we all deserve decent health services. That’s something ASMS is completely behind too.”
What happens to regions when people cannot get health care in their own towns?”
– NIC MEADOWCROFT
A BREATH OF FRESH AIR
A rural general practitioner on the West Coast has reached a significant realisation about the importance of work–life balance operating in an environment of constrained health resources.
Being surrounded by the majesty of the Franz Josef glacier would mean little if doctor Calvin Davis was stuck inside his office 24 hours a day.
Davis says the key to attracting and, more importantly, retaining rural doctors is to ensure they have work–life balance so they get the opportunity to enjoy their surroundings.
He says there is a way for telehealth services, if used correctly, to assist doctors to reduce their on-call and clinical workload and allow for this.
“If I was totally slammed and could never enjoy the lifestyle afforded by being here, I would likely not be here,” he says.
“If I had to work all the time, I would work somewhere else. Likely back in the States.”
Davis first worked at Franz Josef as a locum and liked the experience so much he applied to take on a permanent role.
“Recruitment out here should be easy,” he says. “Fly doctors in and put them on a helicopter touring around for a day or two.
They’ll stay. I did.
“Rural medicine is not for everyone but we can try to bring more people in. We do need to speed up the recruitment process. I wanted to come here and it took four months to get it approved through Te Whatu Ora. It’s too long.”
Davis now acts as a public GP for five remote West Coast clinics across five townships. This role comes with a unique sets of challenges. Davis says he gives the job his all but, when the time comes, he remembers to clock out. It is not his job to staff and fund the hospital, just do his best for his patients.
In the last two months Ka Ora telehealth services have been rolled out to communities on the West Coast. Davis says this will likely have a positive impact on Franz Josef – after some conditions have been met.
“My biggest concern with telehealth is how medicines are given and prescribed to patients,” he says.
“I do not want my job to turn into a dispensary for Ka Ora medicines. Nor do I want to pass
MATT SHAND, JOURNALIST
WEST COAST DOCTOR CALVIN DAVIS.
Greymouth Hospital is 2.5 hours away by road, so it makes you think very hard before doing any imaging.”
– CALVIN DAVIS
on powerful medicines to patients without my own diagnosis.
“As doctors, we are responsible for what occurs once we pass on medicines and I would want to conduct my own analysis. That does eat away at the appeal of Ka Ora in some cases. I’ll still need to see the patient.”
However, because the southern part of the West Coast has only one doctor spread between five clinics, he believes there will be some increase in the overall provision of healthcare and it will help with retention.
He simply cannot be awake and on call all the time. Telehealth can offer some support.
“Because Franz Josepf is already remote, I do not think Ka Ora takes away from the services we already offer,” he says.
“I never want to be on call. Anything that reduces the burden on doctors of being on call is a good thing for rural communities. People, including doctors and nurses, come to areas like Franz Josef for the lifestyle.
“There are more nurses but just the one doctor.” Davis says he feels supported by the community and they respect the boundaries he has placed
around himself, trying to keep boundaries around his work hours.
“I am there for the work and will give it my all for the time I am rostered,” he says. “If I am called to an emergency, of course, I will respond.
“I have told patients that have come in close to closing that I will be leaving at five and will do everything I can to see them before then. But sometimes I have to arrange to see them another day.
“The community spirit is high and they respect me. They know I cannot be working here five days a week and then be on call for the remainder of the week.”
Sometimes the community is called on to lend a hand.
“I had one patient who needed a procedure, and I really needed an extra set of hands,” Davis says.
“The nurse was away so I asked another patient, who the first person knew, if they were comfortable lending me a hand for a simple procedure. I really needed someone to dab when I told them to. They all agreed and it was a bit of a surreal experience, but it showed the potential for rural medicine in the town. Everyone helps.”
The biggest challenge he faces working rurally is the limited access to resources.
“It makes you really focus on what needs to be imaged and what tests you really have to have run,” he says.
“Greymouth Hospital is 2.5 hours away by road, so it makes you think very hard before doing any imaging.”
Because of this, Davis says providing rural doctors with medical tools, or at least allowing CME funds to be used to purchase tools, helps with staff retention.
“I managed to get a portable ultrasound unit to assist me. It is called a ‘Butterfly’ and I was able to eventually get CME funds to pay for it,” he says.
“I cannot imagine doing my rural job without this tech.
“It allows me to do echocardiograms, look for pneumonia and, in rural medicine, that makes a big difference. Melanomas are also a big issue out here, so I was able to secure a dermascope to allow me to provide some quality of care to patients.”
“When you think about it, this equipment is much more useful to a rural doctor than a four-star resort in Fiji for a medical conference – and it costs about the same.”
IT IS ROCKET SCIENCE
MATT SHAND, JOURNALIST
Unlikely as it sounds, Dr Lisa Brown is leading a space-focused health research group here in Aotearoa.
Medical advances on Earth increasingly have their origins off planet says Lisa Brown, hepatobiliary surgeon and head of the New Zealand Space Health Research Network (NZSHRN).
Brown has combined her knowledge of medicine and astrophysics to launch the NZSHRN, which aims to enhance medical knowledge through space exploration and seek ways to apply that research back on Earth.
“Translating technological advancements made in space is a big part of what the network will do,” says Brown.
“A good example is the invention of the continuous glucose monitor. It came out of a NASA research project but was not initially designed to do that. Only later was it adapted for use in the health field.
“Because of the speed at which technology moves in space exploration, these types of invention happen often and we can adapt them for tangible health uses on Earth.”
Studying cancer is another big part of ongoing space health research, due to the effect of microgravity on cancer cells.
“Cancer cells grow and develop faster in microgravity, which speeds up pharmaceutical research and allows for a lot more testing to be done,” she says.
Brown says space health research is about understanding the changes to human physiology when human beings are in space and in a different gravitational environment.
This includes physical changes, such as how the body reacts to the increased radiation
levels outside the Earth’s atmosphere, and psychological factors, such as how living alone in the vacuum of space affects astronauts’ mental wellbeing.
“It’s about how can we monitor these effects and mitigate them,” she says. “It combines the medical knowledge with bioengineering and physics.
“Fluid flow is important without gravity. In micro-gravity if someone suffers a wound, like a cut, the blood does not bleed out of the body. Instead, it forms a sphere that sticks to the body due to the nature of fluid dynamics.
“We also have issues with droplets of blood getting into air recycling systems in the enclosed habitats of space and causing ongoing contamination.
“Wounds do not heal well in space. We also monitor heart activity because the heart does not work as well in microgravity. We need to see what we can learn from that.”
Brown says New Zealand is in a critical position when it comes to leading space health research, given its location and commitment to bioengineering research.
“We are now the fourth largest launch site for space flight in the world,” she says. “Not for manned missions, but we have the ability to send up equipment for research.
“Being isolated and being the gateway to Antarctica, which hosts a lot of psychological space health studies, gives us another opportunity.
“Since we have opened up the NZSHRN we have had a lot of interest, which is very exciting.”
FROM THE FINAL FRONTIER…
Space flight has already helped to bring us a variety of medical devices and procedures, including ear thermometers, insulin pumps and defibrillators. Other notable advancements include:
• digital imaging for breast biopsy systems developed using technology from the Hubble Space Telescope
• transmitters that can monitor a foetus inside the womb
• laser angioplasty using fibre-optic catheters
Cancer cells grow and develop faster in microgravity, which speeds up pharmaceutical research.”
Much of the research at this stage is pivoting towards the impact of prolonged exposure to space travel, in preparation for theoretical manned missions back to the Moon and to Mars.
“The extended exposure to radiation can cause underlying health conditions to resurface,” says Brown.
“There is also the long travel time. What effect does not being in gravity have on bone density, muscle strength and psychology?
“It is also logistics. You cannot bring all the medical equipment you would like to have to hand due to its weight. Space travel is leading medical research into what can be produced via 3D printers. This could lead to future innovations.”
Brown’s interest in space came at an early age and she set off to blaze a career path not many would expect in New Zealand over the last 20 years.
In addition to her surgical training, she completed training and research in aerospace medicine, including a fellowship at the aerospace medicine research arm of the University of Oxford, as well as medical courses at the University of Texas that included working with NASA.
“I was the first New Zealander to study this course,” she says.
She also was part of the organising committee of Women in Space Aotearoa New Zealand and now leads the New Zealand Space Health Research Network.
She hopes her work at the latter will make careers in space easier for the next generation.
“It is trying to pay forward some of the kindness I received in my training,” she says.
“Throughout my training I was always amazed by the astronauts, and the doctors who were astronauts, who would share their knowledge and put their bodies, and lives, on the line to advance this field of research.”
People interested in joining the NZSHRN can visit their website spacehealth.auckland.ac.nz or email spacehealth@auckland.ac.nz
• cooling suits to lower body temperatures in the treatment of various conditions
• programmable pacemakers
• enhancements of MRI and CT digital image processing
• the left ventricular assist device (LVAD), which is based on the design of the Space Shuttle’s fuel pump.
DR LISA BROWN.
SOURCE CODE
LUCY GIBBERD, MEDICAL PROTECTION SOCIETY
There are a range of special considerations when you receive unsolicited information from a third party in relation to the treatment of a patient.
Normally when you are working in medicine, you gather clinical information about a patient from the patient or from other clinicians involved in their care. But, every now and then, you receive an email or a phone call from a concerned neighbour or relative who wants to tell us something relevant about your patient. This can put a clinician in a tricky position, particularly if that person specifically ask you not to tell the patient what they have disclosed.
Defining the issue
Third party information is information you obtain about a patient which comes from a source other than the patient, another clinician involved in that patient’s care, or the clinical records made by another clinician about that patient. Unsolicited means the information has not been requested. The person who is providing the information is usually doing so on their own initiative.
Some examples of unsolicited third-party information might include:
• A daughter ringing up telling you that her father is drinking too much
• A neighbour emailing telling you that they believe a patient isn’t fit to drive
• A patient’s friend writing a letter telling you that the patient may be selling their medication.
Unsolicited third-party information would not include a letter from another clinician who is involved in the patient’s care or an email or phone call from the patient themselves, or someone who holds an activated enduring power of attorney for that patient.
Handling the information
The specific rules that govern how you should handle unsolicited thirdparty information are set out in the Health Information Privacy Code (HIPC). However, there are also ethical and professional considerations that clinicians should keep in mind.
Doctors must not lie to or deceive patients and you should never promise, or even suggest, to others that you will. Patients have a right to their own
information, which includes information about them which their doctors are acting on. There are exceptions to this, but generally the above applies.
Third-party information needs to be handled differently from other health information. Under the HIPC there is an obligation to verify any information before adding it to a patient’s notes or acting on it. This normally (but not always) involves talking to the patient about the information you have received. But information should only be added to notes once it has been verified.
There are times when you have discretion not to release information about a patient to a patient, but this would be a rare exception and it is not something you can ever guarantee to someone who is providing you with third-party information.
You can refuse a patient access to their own health information (even if it is in their notes) if you believe that the disclosure would do one of two things:
• Be likely to pose a serious threat to the life, health, or safety of any individual, or to public health or public safety
• Create a significant likelihood of serious harassment of an individual.
The seriousness of the harm or harassment would have to be significant before refusing the patient access to their own information could be justified. If you believe this is the case, you should contact your privacy officer before proceeding (and they may choose to seek medicolegal advice).
Just upsetting people would not normally be considered a serious threat.
You also need to ensure that the person providing the information understands that you will need to verify that information before acting on it – and that that may involve telling the patient about the information. Promising that person you will not tell the patient who shared the information with you would be a promise you may not be able to keep.
If the person providing the information will not allow you to verify it and wants the information to remain secret, you have the option of rejecting the information. You should tell the informant you are rejecting the information – because you are unable to collect information from third parties unless it can be verified. In this situation you will not add the information to the notes or otherwise retain it, and it will not be acted on.
“You have discretion not to release information about a patient to a patient, but this would be a rare exception and it is not something you can ever guarantee to someone who is providing you with thirdparty information.”
Implications
In the first instance, if you receive unsolicited third-party information – whether via email, letter or a phone call – you should not record that information in the patient notes. This means those emails should not be added to the inbox, and points from the phone conversations should not immediately be added to the notes – either in the body of the notes or in addendums.
You should let the person providing the third-party information know that, if they wish you to save and act on the information, you cannot guarantee you will not tell the patient about the information or who provided it. You should explain that you have an obligation to verify any such information and normally this would involve discussing it with the patient.
If they want to proceed, and once the you verify the information, it will become clinical information and part of the patient’s health record.
If the informant does not give you permission to verify the information with the patient, you should let them know that you will talk to your privacy officer, but it is likely the information will be rejected, and you will not act on it.
If the informant chooses not to share the information, because they do not want it to be shared with the patient, but there is a serious risk of harm (such as a patient who is driving in an unsafe manner), then the informant should be advised that they can go to the Police with their concerns. The Police do not necessarily have to tell the patient who they have collected information from.
If the informant does give permission, then you can decide how best to approach verifying the information before you include it in the notes.
If release of the information could pose a serious threat to the patient’s or someone else’s life, health or safety, it can be marked as confidential. The clinician can then consider if it is safe to share it with the patient if they were to request it. This situation is likely to be rare and you should discuss it with your privacy officer before you add anything to the notes.
If you are not sure whether the situation would be considered unsolicited third-party information, discuss this with your indemnifier and, in the meantime, refrain from adding the information to the patient notes. Your computer system should have a file where unsolicited third-party information can be held before it is either verified or rejected.
This feature was omitted from most printed copies of the September issue of The Specialist due to a printing error. As a result we are re-printing it in this issue.
A REAL-WORLD EXAMPLE
The wife of a patient emailed a psychiatrist with information about her husband. She was concerned about his mental health and described his actions and behaviours at home. She specifically asked that this information was not shared with the patient (her husband). The information was accepted and scanned onto the patient’s clinical record.
Some months later the patient asked for a copy of their hospital notes and the email from their wife was shared with them. This had a considerable and ongoing impact on the family.
In retrospect the psychiatrist wondered if they could have redacted this email from the notes before providing them to the patient, on the basis that release would be likely to pose a serious threat to the life, health, or safety of an individual. However, this is a very high bar and the Privacy Commissioner would potentially look at this and consider how serious that threat might be. Just upsetting people would not be considered a serious threat.
It may have been better to consider whether this information should have been accepted in the first place and whether it was appropriate to act on information which had not be verified with the patient.
New SMO accommodation in Wairarapa
Make a submission on the Treaty Principles Bill
Growing number of branch committees
New ASMS staff
IN BRIEF
NEWS FROM AROUND THE MOTU
NEW
SMO ACCOMMODATION IN WAIRARAPA
Four Winds have brought a breath of fresh air for senior medical officers in the Wairarapa who are celebrating their new SMO lounge and accommodation facilities.
Ngā Hau e Whā officially opened on October 18 with a ceremony involving local kaumatua, Te Whatu Ora management and ASMS representatives.
The facility includes office space, study space, meeting rooms and overnight accommodation for SMOs. ASMS Executive Director Sarah Dalton donated a coffee machine for the kitchen and an ongoing supply of coffee for staff.
Executive operations leader for Health New Zealand Wairarapa Kieran McCann said it was a big occasion to finally have the SMO lounge open.
“It may not be a big moment but it is a big thing,” he said.
“This is significant given the number of SMOs we have and the ongoing need for them stay overnight. The facilities are vastly improved. It is a place for our doctors to relax and recover. A place where they can coordinate, collaborate and continue to be the health leaders they already are.
“There were a lot of challenges in getting this place open and I am glad that struggle is now
over. It has been a personal goal of mine to get it done.”
The name Ngā Hau e Whā, or Four Winds, was chosen to represent the diversity of the SMO workforce.
“Our SMOs come from all over the world to give New Zealand their knowledge, their expertise and their compassion,” McCann said.
“It seemed fitting to have that name assigned to this facility which gives them a collective identity.”
ASMS Branch President Normal Gray said the facility will strengthen the relationship between SMOs.
“It means when you are doing observations you can stay closer to where you are needed,” he said.
“It is also a place where I can imagine us sharing ideas, communicating and working on ways to treat patients better.
“It is much better than being shoved into a cupboard. My whole 10 years I have worked here, this has been needed.”
Adequate overnight accommodation is a requirement under Te Whatu Ora’s collective agreement with ASMS. However, across the country, compliance with this provision is patchy at best.
Decent facilities are also a key part of SMO retention.
Dalton says she wants to see more facilities, like Ngā Hau e Whā, open up across the country.
“It is a core requirement for hospitals to have adequate accommodation facilities when SMOs are required to stay overnight,” she said.
“Having ready access to rest rooms, showers, comfortable beds makes a large difference when you have to be on call throughout the night.
“The ongoing collaboration these additional facilities bring will also strengthen the working relationship between SMOs and boost workforce moral.”
MAKE A SUBMISSION ON THE TREATY PRINCIPLES BILL
The Principles of the Treaty of Waitangi Bill is open for public submissions until 7 January 2025. Toi Mata Hauora is strongly opposed to the Bill on numerous grounds:
• The Bill is not an accurate representation of Te Tiriti o Waitangi and is not supported by expert opinion.
• Inequitable health outcomes for Māori are a significant safety and quality issue the health sector has been working to address. This Bill will be detrimental to achieving that.
• Te Tiriti o Waitangi and its principles provide a pathway to address inequitable health outcomes and build a strong health system where everyone living in New Zealand can thrive. This position is supported by numerous bodies that represent the medical profession, including education and standard setting bodies, regulatory authorities, and unions.
• The Bill, and the process for its advancement, risk damaging Māori-Crown relations, and alienating and excluding
Māori. The Ministry of Justice has highlighted the Bill poses a threat to social cohesion. This is a harmful prospect for both Māori and non-Māori.
Toi Mata Hauora is encouraging members to consider making their own submissions.
If you want to see some further information about the bill, the direction being taken by other unions and a link to follow to make your own submission to the select committee visit union. org.nz/how-to-make-a-submission-on-thetreaty-principles-bill
ASMS EXECUTIVE DIRECTOR SARAH DALTON AS THE NEW SMO FACILITY IS OPENED.
THE FACILITY INCLUDES COMFORTABLE OVERNIGHT ACCOMMODATION.
GROWING NUMBER OF BRANCH COMMITTEES
South Canterbury district has shown the power of creating union branch committees, following a community protest over proposed changes to clinical leadership and hospital organisation.
Under ASMS’ constitution, branch officers of any branch can establish a branch committee “to assist them to conduct the business of the branch”.
As a way to coordinate activity in the branch, branch committee meetings can be more regular and less formal than the pre-meetings for Joint Consultative Committee. They allow for a more informal sharing of issues across hospital departments and create another way for members to connect with each other and troubleshoot ideas.
In the recent clinical leadership review, there was a proposal to move Timaru’s clinical leadership to Dunedin. Clinicians were not supportive of the idea.
“We decided that we needed to speak with the mayor and members of Parliament and
NEW
ASMS STAFF
Jane Lawless has joined ASMS as an industrial officer for the Whanganui, Wairarapa, Tairawhiti and Palmerston North regions. She will also be supporting Hawkes’ Bay.
Prior to joining ASMS, Lawless worked with the public health agency as a programme manager and worked in the Covid-19 directorate.
In a union capacity, she was also a longstanding delegate with the New Zealand Nurses Organisation and worked overseas with European health unions.
“Coming back to the health system after a gap, there has been a pronounced shift in workforce issues and I am looking forward to working with ASMS, and members, to address these as much as we can,” she says.
“In the short term I aim to get out into the districts, meet with you all and champion issues facing our health workforce.
Lawless is an avid bridge player and also was a member of the Lake Geneva Symphony Orchestra where she played the French horn.
become more active in the community space,” Branch President Peter Doran said.
“Being part of branch committee empowers us to act when we are wearing that hat.
“A lot of clinicians want to be active and be more engaged but are not always sure about the best way to do that. Branch committee meetings help organise this.”
Following political meetings, more than 200 members of the public turned up to Timaru Hospital in November to picket against the clinical leadership proposal.
Doran says it is time that clinicians became more active and use their voice to speak out wherever possible He encourages other hospitals to arrange branch committees.
Canterbury has had a branch committee for some time and branch committees have been recently set up in Whangarei, Waitematā, Auckland, Tauranga, Whakatane and Nelson.
“It is about creating constructive working relationships with local management to resolve member issues,” Doran said.
ASMS industrial officer Helen Kissell helped set up Timaru’s branch committee.
“They allow greater discussion between members from different departments,” she said.
“We are most effective when we are working together as a collective to address workplace issues.”
Engaging with media has also proven a useful tool and the branch committee meeting helped identify issues, and spokespeople to talk to topics.
“It is good to provide people with another source of information,” Kissell said.
“It is powerful for decision makers, and politicians, to hear directly from doctors.”
Members wanting to establish a branch committee, or wanting to find out more are encouraged to contact their industrial officer.
Helen Kissell is the new industrial officer for South Canterbury and Waitaha.
Kissell has worked for more than 10 years as an organiser for the New Zealand Nurses Organisation and has supported members within Te Whatu Ora, primary care, hospice, private and aged care sectors.
“I am looking forward to bringing this union and health experience to my role at the Association of Salaried Medical Specialists,” she says.
“Prior to these roles, I worked in the Tertiary Education Union firstly as a vice-president and then as an organiser.
“It is an extremely difficult time, and changing environment, within the health sector right now and I look forward to working with members to ensure their issues are addressed.”
James Roberts joins the ASMS policy team.
He has been a researcher, organiser and project coordinator with a range of unions including the New Zealand Nurses Organisation | Tōpūtanga Tapuhi Kaitiaki o Aotearoa (NZNO) and the New Zealand Educational Institute | Te Riu Roa (NZEI) as an organiser, and as a project coordinator with the New Zealand Council of Trade Unions | Te Kauae Kaimahi (NZCTU).
With the NZCTU, James worked on the Fair Pay Agreements legislation and, following its repeal, how unions could reimplement and improve sector-wide bargaining under future governments. His research interests also include economic planning, political organisation and critical pedagogy.
SOUTH CANTERBURY BRANCH PRESIDENT PETER DORAN.
ASMS SERVICES TO MEMBERS
As a professional association, we promote:
• the right of equal access for all New Zealanders to high quality health services professional interests of salaried doctors and dentists
• policies sought in legislation and government by salaried doctors and dentists.
As a union of professionals, we:
• provide advice to salaried doctors and dentists who receive a job offer from a New Zealand employer
• negotiate effective and enforceable collective employment agreements with employers. This includes the collective agreement (MECA) covering employment of senior medical and dental staff in DHBs, which ensures minimum terms and conditions for more than 5,000 doctors and dentists, nearly 90% of this workforce
• advise and represent members when necessary
• support workplace empowerment and clinical leadership.
ASMS JOB VACANCIES ONLINE
Check out jobs.asms.org.nz a comprehensive source of job vacancies for senior medical and dental specialists/consultants within New Zealand hospitals and health services.
CONTACT US
Association of Salaried Medical Specialists
Level 9, The Bayleys Building, 36 Brandon St, Wellington Postal address: PO Box 10763, The Terrace, Wellington 6140
P 04 499 1271
E asms@asms.org.nz
W www.asms.org.nz
FOLLOW US /asms.nz /ASMSNZ
Have you changed address or phone number recently? Please email any changes to your contact details to: asms@asms.org.nz
If you have reason or need to seek a reduction or waiver to your annual subscription, please write to us. Our constitution allows for this in certain circumstances. Emails should be addressed to sarah.dalton@asms.org.nz
