SPEAKING TRUTH TO POWER | P5 - ASMS
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T H E M AG A Z I N E O F T H E A S S O C I AT I O N O F S A L A R I E D M E D I C A L S P E C I A L I S T S 122 | MARCH 2020
SPEAKING TRUTH TO POWER | P5
MECA 2020 – A HEALTHY
WORKFORCE | P8
RIGHTING WRONGS ON
GENDER PAY | P10
INSIDE
THIS
ISSUE
ISSUE 122 | MARCH 2020
03 SAYING THANKS AND LETTING GO
04 PRESSURE POINTS AND PRIORITIES
MORE WAYS TO GET 05 SPEAKING UP FOR PATIENTS
YOUR ASMS NEWS MPS ASKED TO UPHOLD SMOS’ RIGHT TO SPEAK OUT
You can find news and views
relevant to your work as a specialist
07 YOUR RIGHTS AND RESPONSIBILITIES AS PATIENT ADVOCATES
at www.asms.org.nz. The website is
updated daily so please add it to MECA 2020: A HEALTHY SMO WORKFORCE
your favourites or online bookmarks
to remain up to date.
08 A BIT OF MECA HISTORY
We’re also on Facebook, Twitter
and LinkedIn, and links to those 09 NEWBIE NEGOTIATORS
pages are at the top of the ASMS
website homepage. 10 GENDER PAY: PUTTING RIGHT TO WRONG
13 UNMASKING THE CHALLENGES AND REWARDS OF HOSPITAL
DENTISTRY
14 “NOT UNWELL ENOUGH”
15 2020: A WATERSHED YEAR FOR HOSPITAL SERVICES?
16 A HELPING HAND IN THE PACIFIC
17 TESTING POSITIVE AT FAMILY PLANNING
HAERE MAI TO MINISTRY OF HEALTH MEMBERS
18 NEW ADDITION TO ASMS INDUSTRIAL TEAM
19 WOMEN IN MEDICINE
20 IMPORTATION OF MEDICATIONS
The Specialist is produced with the generous
support of MAS.
22 FIVE MINUTES WITH DR YAN WONG
MORE PUBLIC SCRUTINY OF DHBS
ISSN (Print) 1174-9261
ISSN (Online) 2324-2787 23 VITAL STATISTICS
The Specialist is printed on Forestry
Stewardship Council approved paper
24 BRIEFLY...
SPECIAL HONOUR FOR DOCTOR KILLED IN CHRISTCHURCH
25 MOSQUE ATTACKS
DID YOU KNOW?
26
Proposed position for FSC logo and text.
Please align to bottom of this margin. Q&A COVID-19
27 COMING UP IN THE NEXT ISSUE OF THE SPECIALIST
2 THE SPECIALIST | MARCH 2020
SAYING THANKS AND
LETTING GO
SARAH DALTON | ASMS EXECUTIVE DIRECTOR
W hichever way we look at it, it’s going to be a big year. We’re already in bargaining for a new ASMS DHB MECA. The Simpson
Review of the health and disability system will land sometime soon – possibly even as this goes to print, and there’s an
election looming. Oh, and there’s also the evolving Covid-19 pandemic on our doorstep. We have a lot on our plates.
Meanwhile, we have the long-standing On the bright side, I’m not tackling all these a bit. For those of you who have shared
issues of creaking and failing hospital things on my own. For starters, you – our important ideas and experiences with me
infrastructure, long-term staff shortages members – are very good at letting us know over the last five years, thank you! You’ve
and challenges to continuity of care. The what matters. Please keep in touch. Next, trusted me to walk with you through some
latter is partly due to understaffing and and crucially, your representatives at branch good times, some truly horrible times,
partly due to changes to some workforce and executive level are working hard to and a lot of irritatingly ‘why do we even
patterns without proper reference to the keep staff and membership joined up and have to do this?’ times. My phone and
impact on others: tired doctors, fed-up heading broadly in the same direction. email contacts are still the same, and you
doctors, doctors who are not listened to, are always welcome to make contact.
doctors who don’t feel heard. For those of you in the north, you can
rest easy knowing that our new northern
When I was an industrial officer (up until Ehara taku toa i te toa
industrial team is ready and able to pitch
about three months ago), I worked at the takitahi, engari he toa in on industrial matters, while I take some
coalface, tackling the short-staffing, plant takitini – success is not the time to get to know our people across the
breakdown, and ‘fed-up-ness’, at close
work of an individual but the central and southern regions, gumboots
quarters. Now I’m trying to look upwards
and outwards to see what leverage we
work of many. always at the ready.
can get further up the tube. Sorry for the No matter where we arrive, after the
weird metaphors … it’s an occupational bargaining is settled, the Simpson Review
hazard when a former English teacher A number of you will have had direct has landed, the votes are counted and a
tangos with Ministry officials and HR experience engaging with our support Government sworn in, one thing I’m very
leads. I’ve already decided that the staff, comms, policy and research teams confident about is that we will continue
notional workforce pipeline is more of a and, of course, with our industrial officers. I our journey together:
wetland, of dubious water quality, with a am very proud of the work they do for you,
tangle of small creeks issuing forth. This Ehara taku toa i te toa takitahi, engari he
and for the support they show to each
toa takitini – success is not the work of an
particular project needs gumboots and other, and to the work of the Association.
individual but the work of many.
careful stepping, not to mention some kind
MIND-SHIFT
of platform where the colleges, Ministry, Notwithstanding all of the above, I wish
DHBs and unions can stop long enough All this means it’s ok for me to stop you plentiful non-clinical time, a written
for a chat, lest we become completely thinking like an industrial officer – recovery time arrangement, a decent
mired in the swamp. whatever that means – and change up MECA settlement, and a peaceful 2020.
WWW.ASMS.ORG.NZ | THE SPECIALIST 3
PRESSURE POINTS
AND PRIORITIES
PROF MURRAY BARCLAY | ASMS NATIONAL PRESIDENT
T hese are interesting times for ASMS and our members. We are setting a path with a new Executive Director after 30 years,
we have initiated MECA bargaining at an interesting time pre-election, we’re facing a Covid-19 pandemic, and the health of
New Zealanders is already under serious threat due to widespread shortages of senior medical and dental staff and other health
care workers.
As noted previously, the Government’s available for new hospital buildings. Of course, the most effective way to
spending on health as a percentage of Routine hospital maintenance has suffered improve doctor well-being is to ensure
GDP has decreased steadily over 10 years due to prolonged underinvestment, and there are enough doctors for patient
(Figure 1), and the current Government’s the additional funding is sorely needed. workload. This requires not only
focus on fiscal responsibility to try and At this stage, however, there has been no widespread job and service-sizing but also
survive more than one term has prevented significant movement on the even more salaries and conditions that are sufficiently
sufficient correction of health spending. pressing need for adequate hospital competitive to retain our trainees and
staffing. Adequate numbers of high-quality attract international medical graduates. It
It appears that the health of the Labour staff would have an even more positive is important that our MECA can compete
party is of higher priority than the health influence on the health of New Zealanders with Australian contracts because we are
of New Zealanders. than new hospital buildings. in the same labour market. The MECA
Over the 10 years, we have observed This is the setting for our MECA negotiating team is keen to collaborate
high levels of senior doctor burnout and negotiations. ASMS research over the past with DHBs on restructuring the salary
fatigue, growing patient waiting times, and 5 years has highlighted fatigue, burnout, scale to give us the best chance to
a reducing range of medical conditions staff shortages averaging 24% (Figure retain and attract early career SMOs
that qualify for specialist medical care. 2), a gender pay gap of over 12% (more in particular. DHB commitment to this
It appears that the reduction in health on p10) , and an average 67% pay gap collaboration is unclear at this early stage,
investment is now leading to sky-rocketing with Australia (see BERL research on the but we are optimistic. If the DHBs step
acute hospital care demand, i.e. double ASMS website), with 1,700 New Zealand away from collaboration, it is possible
the rate of population growth. trained specialists working in Australia. that negotiations may be difficult and
SMOs have few avenues to leverage for prolonged. No one will want this to
The winter peak of overrun emergency improvements to these conditions or to happen, especially with elections looming.
departments and hospital gridlock is reduce doctor migration, and the Ministry
becoming more difficult to cope with each stranglehold on DHB finances makes it Lastly, the Executive is keen to increase
year, and this system overload is now difficult for DHB management to make the the flow of information between members
also occurring frequently at other times required corrections. and National Office to ensure we
throughout the year. It is of major concern understand members’ views and to aid
The MECA is our best tool to improve and
that a Covid-19 pandemic, on top of the negotiations. Over the coming weeks and
maintain SMO well-being. You will see
usual winter influenza peak, which could months we plan a series of single-question
in the ‘MECA Matters’ updates that we
stretch our hospitals and staff beyond or short surveys with rapid feedback that
are negotiating important new clauses
breaking point. focused heavily on well-being. The DHBs members should find quick and interesting.
One very positive piece of recent news do recognise the importance of SMO
is the additional funding being made well-being.
24%
6.8% Core Crown Health as % GDP
South Canterbury (2019) 25%
Vote Health as % GDP
6.6% Southern (2019) 27%
Forecast % GDP
Hutt (2019) 26%
6.4%
Auckland (2019) 20%
6.2% Tairawhiti (2019) 25%
Percentage of GDP
Whanganui (2019) 26%
6.0%
Northland (2019) 36%
5.8% Waikato (2019) 28%
Waitemata (2018) 19%
5.6% Canterbury (2017) 25%
5.4% Counties Manakau (2016/7) 18%
Nelson-Marlborough (2016/7) 17%
5.2% Capital & Coast (2016) 27%
MidCentral (2016) 27%
5.0%
Hawke’s Bay (2016) 22%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
June Years 0% 5% 10% 15% 20% 25% 30% 35% 40%
FIGURE 1: CORE CROWN EXPENSES AND VOTE HEALTH AS FIGURE 2: SMO SHORTFALL AS PERCENTAGE OF CURRENT
PERCENTAGE OF GDP STAFFING ALLOCATIONS
Source: Treasury Source: ASMS surveys of clinical leaders
4 THE SPECIALIST | MARCH 2020
SPEAKING UP
FOR PATIENTS
LYNDON KEENE | POLICY AND RESEARCH ADVISOR
T he importance of senior doctors speaking up when they have unresolved concerns about patient safety is repeatedly raised at
ASMS forums, not least at the most recent annual conference.
When they do speak up, it can lead to increasing hospital workloads have then detailed in a report titled Patients are
significant improvements for patient care. also been playing out in New Zealand, Dying. It sparked a major investigation by
as outlined in the recent ASMS report the Health and Disability Commissioner and
The pernicious impact of health care
Hospitals on the Edge. The cover of that resulted in a major emergency department
staff not feeling able to speak up when
publication – a hospital crumbling over a redesign and expansion.
service standards become unsafe is well-
documented. Among the worst cases is cliff-top – depicts the erosion of hospital In 2004, senior doctors again warned
the tragedy of Mid Staffordshire Hospital services over many years. That erosion that budget constraints were dragging
in England where, largely due to cost- might have occurred more rapidly were it the emergency department back to
cutting and staff shortages, hundreds not for a small number of senior doctors crisis levels. Their alarm prompted
of patients died as a result of poor care who put their heads above the parapet another urgent independent review,
that was allowed to persist for more than to speak out when inadequate resourcing which found major deficiencies and
four years. It was eventually exposed, made services unsafe. In some cases, their recommended further extensive changes.
not by those with immediate duty of care voices led to sweeping changes. The DHB’s response eventually led to
to patients, but by the National Health In the winter of 1996, amid the 1990s’ the development of the internationally
Service regulator, and a woman whose recognised ‘Canterbury Initiative’, creating
market-driven health reforms, seven patients
mother had died. stronger integration across hospital and
needlessly died in Christchurch Hospital.
community services.
Though Mid Staffordshire is an extreme Senior doctors, whose fears had been
example of a health system breaking dismissed by management, were forced to At Waikato DHB in 2016, orthopaedic
under the strain, the pressures of go public with their concerns, which were surgeons went public with complaints that
WWW.ASMS.ORG.NZ | THE SPECIALIST 5
they no longer had faith in management on patients when they don’t pass covering similar issues, found a decline
and that Waikato Hospital was no treatment ‘thresholds’ (see p14 “Not in staff saying that it is easy to speak up
longer a safe place to practise elective unwell enough”). about patient care concerns.
surgery. The exposure prompted the
Very occasionally, even senior DHB Reasons often include fear of retaliation
DHB to recruit more staff. or repercussions, a lack of skills in
management and board members have
In 2017, senior doctors wrote to the raised their heads over the parapet. speaking up, concerns about upsetting
Ministry of Health heavily criticising colleagues, or an attitude of ‘it’s not
In 2018 Dr Lester Levy, then chair of my job’.
Waikato DHB’s management style.
Auckland, Counties Manukau and
They went public again the following
Waitemata- DHBs, slammed a lack An extensive American study published
year with scathing comments on the last year found, unexpectedly, that the
of funding for a law change to give
DHB’s procurement of a virtual health willingness to speak up is not simply
compulsory treatment to the worst drug
technology contract. The chief executive and alcohol addicts. about teamwork training, psychological
resigned in late 2017, and the board was safety training, attempting to create an
sacked by the Minister in May 2019. In 2017 the then acting chair of environment that values staff raising
Canterbury DHB, Sir Mark Solomon, concerns, or any one policy. Rather, the
Late last year, frustrated senior doctors publicly attacked the Treasury and biggest drivers of speaking up related
at Palmerston North Hospital wrote the Ministry of Health over protracted to workforce well-being. The lower
a letter to their DHB, copying in the funding issues. Capital & Coast DHB the levels of burnout and professional
Ministry and the Health Minister, saying Chief Executive Ken Whelan stepped frustration, and the higher the levels of
a crisis over the lack of adequate down in 2010 because he said the organisational engagement, decision-
facilities and space was affecting their Government was forcing him to cut so making and regular constructive
ability to meet the surgical and medical many costs, he feared he would start feedback on performance, the more
needs of the people of Manawatu-. cutting into muscle and undermine likely it is that staff will feel comfortable
The letter was sent by the combined patient care. about speaking up.
medical staff executive group, backed
by 80 senior hospital doctors. It led to RELUCTANCE AND FEAR In other words, the time when speaking
an urgent visit by health officials and up becomes more vital – when staff are
An ASMS national survey of members
constructive discussions about how burnt out and disengaged – is precisely
in 2018/19 on clinical leadership found
when staff are less likely to do so.
senior doctors could help to improve that while most felt able to speak to
the facilities. their colleagues about patient safety Christchurch surgeon and Canterbury
concerns, there was a reluctance to Charity Hospital founder Dr Phil
raise concerns further up the chain. Bagshaw and University of Canterbury
Less than half of respondents felt able academic Pauline Barnett asked
In other words, the whether advocacy by doctors should
to speak out to their Chief Medical
time when speaking up Officer or equivalent, and only a be an obligatory component of medical
becomes more vital – when quarter felt able to bring concerns to professionalism in a paper published
staff are burnt out and the attention of the Chief Executive. in the New Zealand Medical Journal
disengaged – is precisely Just 4% said they felt able to speak out – ‘Physician advocacy in Western
to the media. medicine: a 21st-century challenge’ – in
when staff are less likely
December 2017.
to do so. This is despite the provision in the
ASMS DHB MECA that enables senior Speaking to Radio New Zealand after
doctors and dentists to comment publication of the paper, Dr Bagshaw,
publicly “on matters relevant to one of the doctors behind the 1996
More recently, Middlemore Hospital Patients are Dying report, said we
intensive care specialist David Galler their professional expertise and
experience”, after having discussed need to question whether doctors
and Palmerston North paediatrician should be vocal or not – and what the
Jeff Brown, with support from ASMS, the issues with the employer. It is also
despite efforts by the Health Quality consequences are if they’re silent.
spoke out against the Government’s
& Safety Commission and some DHBs “Doctors are the people best placed to
decision to allow the food industry
to encourage staff and patients to see things going off the rails,” he said.
to continue self-regulating fast food
speak up through various ‘speak up’
advertising. And in this edition of The “If we aren’t the ones who can see
programmes.
Specialist, North Shore anaesthetist where the problems are, then who can?
and ASMS Vice-President Julian Fuller Further, Otago University surveys of And I think the public expects us to
is raising concerns about the effects health professionals in 2012 and 2017, speak out on their behalf”.
6 THE SPECIALIST | MARCH 2020
MPS ASKED YOUR
TO UPHOLD RIGHTS AND
RESPONSIBILITIES
SMOS’ RIGHT AS PATIENT
ADVOCATES
TO SPEAK OUT
T he ASMS-DHBs Multi-Employer
Collective Agreement (clauses 39-41)
includes a number of provisions regarding
members’ responsibilities to their patients,
their patient advocacy roles, processes
A SMS has called for amendments to the Public Service Legislation Bill,
which is currently before Parliament.
for resolving any concerns about patient
safety, and the right to speak publicly.
The Bill reorganises the State sector and gives stronger powers to the State • The parties recognise: (a) the primacy of
Services Commissioner, who will be renamed the Public Service Commissioner. the personal responsibility of employees to
In presenting ASMS’ submission on the legislation, ASMS Deputy Executive their patients and the employee’s role as a
Director Angela Belich said the key issue for senior doctors and dentists patient advocate.
is whether it will fetter their ability to speak out in defence of patients, to • In recognition of the rights and interests
critique standards or to defend the public health service. of the public in the health service, the
She told MPs that the right to speak out was essential in the 1990s when employer respects and recognises the
attempts to privatise the public health system were met with principled right of its employees to comment publicly
professional critiques from specialists. and engage in public debate on matters
relevant to their professional expertise
The right to speak out is protected by Clause 40 of the Collective and experience.
Employment Agreement covering senior doctors and dentists and schedule
1B of the Employment Relations Act. • In exercising this provision employees shall,
prior to entering into such public debate
But Angela Belich said the present State Sector Code of Conduct has been and dialogue, where this is relevant to the
used by DHBs, particularly around elections, in a way that has had a chilling employer, have advised and/or discussed
effect on this important freedom. the issues to be raised with the employer.
For example, she said, policies have been put in place requiring all • Employees who have serious concerns over
communications to go through DHB communication teams. This had led to actual or potential patient safety risks shall
a reluctance by ASMS members to comment when funding or contracting make every reasonable effort to resolve
issues will affect continued employment or the viability of a service. them satisfactorily with the employer.
ASMS is concerned that any further restriction on the rights and obligations of • Where either the Association or the
senior doctors and dentists and other health professionals to speak out publicly employer believes that the serious concerns
over issues of funding, deteriorating infrastructure and burgeoning unmet need remain unresolved, they shall develop a
may mean New Zealanders lose access to the advice from the experts they pay process for resolution of these concerns.
for and depend on for their protection against ill-founded policies.
These are under-used provisions that
Angela Belich called for the Bill to be amended so that the Public Service members are encouraged to consider
Commissioner must give effect to the right of senior doctors and dentists making greater use of. Similar provisions
to speak publicly on on the rights to speak publicly are
matters related to their reinforced in Schedule 1B of the Employment
professional expertise. Relations Act.
“The Commissioner It’s usually up to the Executive Director or
should be an ally of the the President to speak publicly on behalf
public in upholding the of ASMS although branch officers also can,
public’s right to know, if they have ASMS clearance. However
which is dependent on any member, or group of members, may
our members’ right to go public with their concerns as outlined
tell,” she said. above, speaking as individuals or with a
The Select Committee is collective voice.
due to report back on the Any member who has a current concern
Bill on 28 April. and needs advice or assistance to resolve
it should contact a local ASMS branch
The full submission is on
representative and/or an industrial officer.
the ASMS website:
www.asms.org.nz under ASMS is developing guidelines and advice
publications. for members around speaking up for
patients. Look out for it shortly.
Angela Belich
WWW.ASMS.ORG.NZ | THE SPECIALIST 7
A BIT OF MECA
MECA 2020: A HISTORY
HEALTHY SMO MECA ONE – The first MECA was
WORKFORCE
negotiated in 2003, combining
the 21 DHB collective agreements
that were in place at that time. It
standardised many critical conditions
LLOYD WOODS | SENIOR INDUSTRIAL OFFICER/LEAD MECA ADVOCATE such as six weeks of annual leave,
salary scales with annual increments,
T1.5 for afterhours duties for most
M eeting New Zealand’s health needs relies on the retention and growth DHBs, recognition of non-clinical time,
of our specialist workforce. Right now, New Zealand has too few senior and a 6% employer contribution to
doctors, and many patients are missing out. We also know that SMOs/SDOs superannuation.
are working to exhaustion and near burnout, and we need to see greater MECA TWO – Negotiations were
investment in the specialist workforce. acrimonious and lengthy. The DHBs
That is why we have ambitious goals for this year: safer workplaces, improved came to the table with stated limited
well-being conditions, and mechanisms to tackle recruitment and retention. All fiscal parameters and rejected most of
will help deliver better patient-centred care. ASMS’ claims for improved conditions.
Worse, they sought ‘clawbacks’
Our ambitions can be seen with the large number of claims we’ve tabled in the
to previous conditions. Members
MECA negotiations.
showed their resolve with stopwork
There are 55 claims covering issues such as gender pay equality, fair recognition meetings and a national ballot
for working anti-social hours, better recovery time after shifts, and safe staffing. in favour of industrial action. The
Minister of Health became involved
We have also tabled a set of principles to help us tackle the trans-Tasman salary
and the MECA was settled with
divide, which was highlighted in last year’s Business and Economic Research Ltd
enhanced principles of engagement
(BERL) report. The salary claim is challenging. It needs some creative thinking,
for members and a doubling of the
and we need salary scales that look ahead so we can level the recruitment
cap on continuing medical education
playing field.
(CME) expenses to $16,000.
At the time of writing, four days of MECA talks have been held. There are now
MECA THREE – Negotiations began
another eight days scheduled before June.
in late 2009 and continued through
KA MUA, KA MURI 2010 and 2011. The slow progress
was due mainly to the inclusion of
“Ka mua, ka muri” – “We must look back in order to move forward.”
joint workshops on the state of the
History shows us that MECA negotiations are never easy (see box). In previous SMO workforce, the development of
years the DHBs have intentionally and successfully dragged them out. In some a joint business case, and the use of
cases, they’ve delayed a salary increase and avoided backpay. On occasion we variations to the previous MECA for
have called on members to stand up to achieve a result. We hope that won’t be an interim agreement. Settlement was
the case this time, but it might be. achieved with a compromise between
building a more acceptable salary
What we do know is that the DHBs would like to move as many matters as they
scale but seeing members stuck on
can outside the scope of MECA bargaining. They are worried about the size of
the top step.
the settlement envelope and want to take a problem-solving approach. We have
not had a good experience with working groups, including a failed attempt at a MECA FOUR – ASMS tabled a narrow
working group on afterhours remuneration, which fell out of the last MECA. claim based mainly around salary.
It was dismissed out of hand by the
We want detailed responses to, and discussion of, our claims. We’ve spent several
DHBs, but members showed little
months developing claims for bargaining. Those 55 issues are there because
appetite for a fight and the MECA
they’re worth proper consideration at the table. We have learned our lessons
was settled with a modest salary
from the past, and we are committed to making our days in bargaining focused increase aimed largely for those at
and productive. the top.
WHAT’S NEXT? MECA FIVE – Negotiations for the
If we need all the scheduled negotiation days, we’ll finish bargaining in June. At current MECA took around 14 months
that point we’ll be weighing up whether we’re close to achieving a settlement or and were difficult due to the DHBs
not. If we are not very close to agreement at that point, we will most likely come sticking rigidly to inflexible financial
back to members seeking a mandate for next steps. parameters for several months and
looking for clawbacks. After 14 months
Look out for our ‘MECA Matters’ bargaining updates. We welcome your feedback a reasonable outcome was achieved,
as we go. including additional steps on the top
We will not get everything that we have claimed, as that is the nature of negotiation, of both scales. It expires on 31 March
but we can assure you that our team will be doing its very best to get outcomes that 2020.
all members deserve.
8 THE SPECIALIST | MARCH 2020
NEWBIE NEGOTIATORS
Dr Alain Marcuse Dr Jenny Henry Dr Tom Morton
N egotiating a collective agreement is a long way from the day job of a medical specialist. There are several first timers on the
MECA bargaining team. We asked three of them - Dr Jenny Henry (anaesthetist, Northland), Dr Tom Morton (emergency medicine
specialist, Nelson) and Dr Alain Marcuse (psychiatrist, Wellington) - a couple of quick questions after the first round of negotiations.
WHY DID YOU WANT TO JOIN THE WHAT EXPECTATIONS DID YOU HAVE Dr Tom Morton: I work in a fast-paced
MECA NEGOTIATION TEAM? ABOUT THE PROCESS? speciality, this is anything but.
Dr Jenny Henry: I think it’s fantastic to Dr Jenny Henry: I had no expectations. Dr Alain Marcuse: Eye-opening and a steep
represent Northland and I’m interested learning curve, solidarity among colleagues.
Dr Tom Morton: I was told not to expect
in the entire process having never been
anything except frustration. WHAT IS YOUR BIGGEST TAKEAWAY
involved in anything like this before.
SO FAR?
Dr Alain Marcuse: To see a political
Dr Tom Morton: Rather than shouting
process which is difficult to understand Dr Jenny Henry: How fortunate we are to
from the side-lines I wanted to get
with my current level of expertise. have Lloyd Woods and Murray Barclay as
involved in the scrum.
our advocates.
WHAT WOULD YOU SAY TO OTHER
Dr Alain Marcuse: To understand the
MEMBERS ABOUT THE EXPERIENCE? Dr Tom Morton: You need to fight for what
forces forming the working environment
you believe in.
and support my colleagues shaping the Dr Jenny Henry: It’s very early days.
future of the health services in After two days it’s very interesting and a Dr Alain Marcuse: Every coin has two
New Zealand. massive eye-opener to the whole process. sides, and we might face a long-lasting
process of bargaining.
The entire MECA negotiating team 2020
WWW.ASMS.ORG.NZ | THE SPECIALIST 9
GENDER PAY: PUTTING
RIGHT TO WRONG
ELIZABETH BROWN | SENIOR COMMUNCIATIONS ADVISOR
A SMS is taking action to close the gender pay gap.
We will be asking DHBs to conduct gender pay audits and have backed it
up with a claim in the ASMS DHB MECA that is currently being negotiated.
Over the years ASMS has been alerted to cases in which women have
received lower job offers than their male counterparts, and others in
which women haven’t been offered the same enhancements.
Historically, such cases have been viewed as one-off slips of unfairness,
rather than a systemic gender issue.
Last year ASMS sought to partner with the Auckland and Waikato DHBs
to undertake research into the gender pay inequality, but despite early
enthusiasm, the DHBs said they had no capacity.
So ASMS decided to tackle the issue by commissioning independent
research. The study by Motu Economic and Public Policy Research found
an estimated gender pay gap among medical specialists of 12.5%. It was
based on hourly wages earned by specialists working in DHBs. It widened
even further once women had children.
The research has been shared with DHBs.
ASMS Deputy Executive Director Angela Belich says, “The Equal Pay Act
has been in place since 1972. DHBs have a legal obligation to pay women
the same as men. They have not met this legal obligation, and as a state
sector employer, they should be making it a priority”.
As a result, an equal pay claim has been included as part of the ASMS
DHB MECA negotiations. It says:
(a) Notwithstanding the above, no female employee shall in any case be
paid less than the rate that would be paid to a male employee with
the same, or substantially similar, skills, responsibility, and service
performing the work under the same, or substantially similar, conditions
and with the same, or substantially similar, degrees of effort.
(b) Each DHB will audit salaries at least once per year to ensure that the
principle in (a) above is being complied with.
DHBs have given an early indication of commonality on the claim.
ASMS Research and Policy Director Charlotte Chambers says, “It shouldn’t
be up to the individual to find out if their pay and conditions are unequal
and remedy the problem. It’s not their responsibility”.
A GOOD GENDER PAY AUDIT
ASMS is now looking to develop what a good gender pay audit would look
like. It has proposed a working group be set up between ASMS and DHBs
to consider the terms of reference, scope, timing and personnel to do the
foundation audit.
It would be based on the following principles:
• It must assess the salary step on appointment of all currently employed
SMOs to ensure women and men of equivalent qualifications and
experience were appointed at the same salary step and progressed
through the scale as specified in the MECA.
10 THE SPECIALIST | MARCH 2020• It must assess all payments over and • Any SMO found to have been underpaid recent job offer, did you accept it as it was,
above the MECA base salary step for because of gender will have that or did you negotiate a better offer?”
all currently employed SMOs (FTE discrepancy rectified from the date at
Of the 337 women who responded:
above 40 hours, availability allowances, which it occurred.
call, recruitment and retention • 216 accepted their first offer
ARE MEN BETTER AT NEGOTIATING?
payments) to ensure that women
• 83 negotiated a better offer
and men of similar qualifications and ASMS National Executive member and
experience receive the same. Palmerston North paediatrician Nathalie • 38 tried to negotiate a better offer but
de Vries was curious to find out more were turned down.
• The FTE and extra remuneration of
about a suggestion made in the Motu
women and men in formal clinical Dr de Vries points out that while it’s not a
research that men may be better than
leadership positions must be assessed scientific poll and not all the women in the
women at negotiating better salaries.
to ensure that women and men have Facebook group are specialists, it reveals
She posed the question on the Women in
equivalent entitlements. some interesting trends and prompted some
Medicine Facebook page: “On your most
salient comments from SMOs (see box).
“HAVE A MALE COLLEAGUE WITH
“Men are better at asking for
it, for sure. When I took my THE TALE
LESS EXPERIENCE THAN ME –
AUTOMATICALLY PUT ON STEP 4
position, I was advised by a
male colleague outside of my OF DR X
department to negotiate for
WHEN NEWLY APPOINTED – DIDN’T
higher ... so I did and got it. I This is a true and recent account
NEED TO NEGOTIATE...” would never have thought of from a female ASMS member
doing that.” about her experience of gender
pay discrimination.
“I hate talking about money “Before this research I would have sworn
– but I am also aware that I Two of my male friends from my
am not as mercenary about
I was being paid the same as my male
medical class and I all ended
money as many of my male colleagues. My checking so far with one up with the same speciality
colleagues, not as motivated male colleague shows salary step ok, but qualifications, with myself and Dr Y
by it, not so dependent on additional payment for having done a gaining those qualifications on the
my job to define me. (Plus, same day, 10 years after graduating
I don’t have a second wife fellowship is being paid to me at half the
from medical school. Dr Z gained
and family to support.)” rate it is to him.”
his qualification 10 months later.
Dr Y and I then went on to further
sub-specialise, and I gained my sub-
“WHEN I WAS NEGOTIATING MY CONTRACT FROM THE UK AROUND specialty qualifications over a year
13 YEARS AGO, I WAS TOLD THAT WOMEN SPECIALISTS HAD LOWER before Dr Y did.
SALARIES COMPARED TO THEIR MALE COUNTERPARTS. I NOW
REALISE I WAS STARTED ON A LOWER STEP THAN I SHOULD HAVE We both started SMO work at the
BEEN AND HAVE REMAINED BEHIND THE MALES WHO TRAINED same DHB at the same time. Dr Y
WITH ME BUT ARE NOT AS WELL QUALIFIED.” was started on Step 3 of the MECA,
but despite extensive negotiations, I
could not get the DHB to go above
*quotes published with permission starting on Step 2.
Meanwhile, Dr Z was started on
Step 1 while still a Fellow and put
up to Step 2 several months later
Dr de Vries believes DHBs need to be referring SMOs with job offers to ASMS once he had his initial qualification.
transparent and be held to account. At the industrial staff to check job offers are fair,
Some years down the track I find
same time, she says female SMOs need monitoring recruitment and promotion
myself three to four steps lower
support and encouragement from ASMS and processes, actively recruiting people
than Dr Z, and a step below Dr Y,
their colleagues to negotiate their starting returning to work after extended career
even though I also have further
salaries, and they should ask questions if breaks, and improving workplace flexibility
qualifications as well.
they believe there are equity issues. for both men and women to reduce the
parent penalty against women. I have estimated that
ASMS is also working on strategies to conservatively across this time Dr
ensure equal pay into the future, such Together we can make the gender pay Z has been paid $100,000 more
as developing guidelines to ensure gap a thing of the past. than I have been, while Dr Y has
equitable placement on appointment, been paid between $30,000 and
$50,000 more over that time.
WWW.ASMS.ORG.NZ | THE SPECIALIST 11Dr Anna Dawson 12 THE SPECIALIST | MARCH 2020
UNMASKING THE CHALLENGES
AND REWARDS OF
HOSPITAL DENTISTRY
ELIZABETH BROWN | SENIOR COMMUNCIATIONS ADVISOR
W hen you ask Dr Anna Dawson to describe her working day, it’s hard not to be surprised by the range of patients she sees.
Dr Dawson works as a general dentist for that people are living longer and ageing “We have a lot of standard declines
Auckland Regional Hospital & Specialist with their teeth. More children are also around patients who are financially
Dentistry, offering complex oral health being referred for specialist treatment disadvantaged and who can’t afford
treatment to some of the region’s most under general anaesthesia. standard dental care, and unfortunately
vulnerable populations. we just can’t accept them”.
The challenges on a national level were
Her patients include children and adults laid out in a report last year by the Public health dentistry is at the sharp end
with intellectual disabilities or brain injuries, University of Otago – Public sector oral of wider public health debates on issues
people who have had organ transplants, health service provision for high needs and such as obesity, sugar tax, community
people who are waiting for heart surgery, vulnerable New Zealanders. water fluoridation and water-only schools.
and people receiving radiotherapy When it comes to young children whose
treatment for head and neck cancers. HIGHER DEMAND
teeth have rotted away from sugary
Broadly, they are patients who can’t be Based on investigations with clinical food and drink, Dr Dawson feels she can
safely treated in private or community leaders, SMOs and SDOs, it found higher contribute more than just treatment.
practice or where the specialist service demand is putting pressure on hospital
dental services, there is inconsistency in “There’s a chance to talk to their families
they require isn’t available.
provision with some DHBs having limited about why this has happened and
There are also children whose teeth are or no services, and staff resources are acknowledge that the things they have
so decayed they need specialist care, or insufficient. Of particular concern were been doing weren’t correct,” she says.
kids in Starship Hospital who may receive workload, training, career progression and “It’s an opportunity to reframe and give
dental treatment while under anaesthesia succession planning.
for another procedure. them a way forward that doesn’t leave them
Service Clinical Director at Auckland feeling shamed or guilty but with the power
“Being able to help people who are Regional Hospital & Specialist Dentistry to make some changes in their family’s life”.
disadvantaged through no fault of their own DHB Oral Health, Dr Hugh Trengrove,
access a service, and deliver that service to A HIDDEN SPECIALTY
says, “We are experiencing increased
them, is very satisfying,” Dr Dawson says. demand for quite complex dentistry The importance of oral health in New
“Often our patients come in quite worried and support services, particularly for Zealand has been historically overlooked,
and scared, and when you say you can elderly patients who’ve got multiple despite its crossover with so many
help and see them, the relief that provides co-morbidities. There is concern as a conditions and medical specialities. The
is wonderful”. profession about how we are going to look University of Otago report identified what
after these people”. it called “the lack of visibility” of oral health
She also feels lucky to be able to work within DHBs and a lack of prioritisation.
alongside a large cross-section of medical He adds that as the Auckland region
specialists, as well as theatre staff and gets bigger, it is difficult to ensure that Dr Trengrove believes that’s changing,
other dentists. services are equitable and reach the most at least in the northern region where
disadvantaged. Auckland’s three DHBs along with Northland
“People are waiting. If they meet the access are in the early stages of developing a near
threshold to see us, we will see them. to long-term plan to improve the population’s
“Being able to help people oral health outcomes.
We haven’t altered our access criteria in
who are disadvantaged order to reduce demand, but people are System change and improvement spins
through no fault of their own potentially waiting longer so we have to be Anna Dawson’s wheels. With the support
access a service, and deliver smarter about how we deliver care. of her DHB and colleagues, she’s spent
that service to them, is very “It would be fair to say hospital services the last two years studying for a Master
satisfying.” in dentistry have traditionally been very of Health Leadership. The final part is a
treatment-focused. We’ve never had service improvement project that she aims
the time or opportunity or willingness to to put to good use in her own department
embrace looking at different models of by looking at the service provided to head
The broad group of patients Dr Dawson and neck cancer patients.
care, and the time is now,” he says.
sees is growing, and their needs are more
complex. It’s a cocktail of population Turning down referrals is a part of the job The bottom-line for Anna Dawson is that
growth, increased demand, and the fact Dr Dawson finds disheartening. hospital dentistry is her ‘right fit’.
WWW.ASMS.ORG.NZ | THE SPECIALIST 13“NOT UNWELL
ENOUGH”
LYNDON KEENE | POLICY AND RESEARCH ADVISOR
I t’s a vicious circle. Non-urgent patients have their treatment deferred, their condition deteriorates to the point where they need
acute care, and they in turn displace more non-acute patients.
There’s growing evidence that under current Like many other specialists around the There’s also clear data to back up the
rationing processes or ‘treatment thresholds’, country, Waitemata- DHB anaesthetist and anecdotal evidence (Figure 1).
patients who are considered “not unwell ASMS Vice President Dr Julian Fuller is
enough” are missing out on treatment. frustrated after seeing it play out first-hand.
“The suffering being
“I have worked as an anaesthetist at containing loops of bowel. experienced by so many
North Shore Hospital for the last 23 patients is largely hidden”
“Before seeing him, I checked his public
years and during most of that time we
hospital notes and saw the ominous
have been the fastest growing DHB
note: ‘Below access threshold. Return
in the country, with funding growing to referrer.’ And he was now forced to Acute hospital inpatient discharges
each year accordingly. It has always go the private route in order to get any rose by more than twice the population
appeared superficially that patients treatment at all. growth rate in the six years to 2018. On
have not had major problems accessing
“A little earlier, I met a delightful the other hand, the increase in non-
care, but over the last few years this has
88-year-old lady for an assessment acute discharges was only half that of
changed. And it has been brought home
for a total hip joint replacement. She population growth.
to me shockingly over recent months.
hobbled into my clinic on crutches, These trends suggest non-acute patients
“Recently I was asked in private to which surprised me. Upon asking
assess a 92-year-old gentleman who in public hospitals are being displaced by
her, she told me she had been using
had been declined a first specialist the steep rise in acutes, made worse by
crutches for 12 months waiting for a first
assessment (FSA) at the hospital. His specialist appointment at the hospital. successive years of budget constraints.
problem (apart from being generally Her GP was unable to get her in The higher case-weighted growth rates
unwell and multi-comorbid) was an because she did not meet the threshold. indicate that priority is also being given to
inguinal hernia, or groin hernia. But it treating the most complex cases.
“I am now told that this is probably the
was not just an inguinal hernia. It was a Dr Fuller says, “The suffering being
norm for most DHBs in this country”.
third-world type inguinal hernia. It was experienced by so many patients is largely
massive, larger than a large orange, – Dr Julian Fuller
hidden. It must be publicly acknowledged,
and DHBs need to be supported by
government to urgently address this issue.
What many of my colleagues and I are
16 Non-Acute (actual) Non-Acute (caseweights) Population seeing is surely not an acceptable level of
14 health care in a first-world country”.
12
10
Percentage change
8
6
4
2
0
2011 2012 2013 2014 2015 2016 2017 2018
-2
-4
Years to June
FIGURE 1: NON-ACUTE DHB INPATIENT DISCHARGES (ACTUAL AND CASE
WEIGHTED) 2010/11 TO 2017/18 Dr Julian Fuller
Source: Ministry of Health Caseload Monitoring Reports
14 THE SPECIALIST | MARCH 20202020: A WATERSHED YEAR
FOR HOSPITAL SERVICES?
LYNDON KEENE | POLICY AND RESEARCH ADVISOR
T he health system faces three potentially significant turning points this year, not to mention the emerging challenges of Covid-19.
When the Health Minister David Clark significant role that ‘treatment’ plays in for this election year Budget.
was in Opposition in 2017, he spoke of ‘prevention’. It is that same idea that is
Given that addressing health inequalities
the mounting pressures on public hospital seeing hospital bed numbers being cut,
is cited as a high priority for the
services as “symptomatic of a growing which in turn is leading to frequently
Government, immediate measures to
crisis”. Since then, things have changed, unsafe hospital bed occupancy rates.
begin to address them, particularly for
but not for the better. As acute admissions
Further, as previously reported, the Ma-ori, must surely be high on the agenda
grow at twice the rate of population
evidence from New Zealand and overseas of health budget bids. No one would argue
growth, bed occupancy rates are hitting
indicates that while measures to improve with that.
record highs, with many wards operating
access to primary care and a greater
at levels exceeding clinical safety A big question for this year’s Budget will
focus on prevention are much needed,
standards for prolonged periods. be whether its funding signals line up with
they do not necessarily reduce the use or government policy aspirations.
ASMS President Murray Barclay said in the need of hospital care.
introduction to the Hospitals on the Edge Council of Trade Unions–ASMS analyses
The reasons include a lack of clear of the Vote Health budgets have shown
report published last November, “There are
evidence to determine the most effective successive years of funding shortfalls.
simply too few staff, too few acute hospital
approaches to prevention, lack of If Vote Health’s operational funding in
beds, too many patients discharged
clinical time, lack of patient compliance, 2018/19 were to match that of 2009/10
before they should be, too many facilities
practitioner attitudes, and financial as a proportion of GDP, a further $1.7
unfit for purpose, and too many patients
disincentives, among others. billion would have been needed.
denied access to timely treatment because
hospitals lack capacity.” There is strong, mounting evidence that A continuation of the current fiscal
integration between hospital services, austerity approach would risk a situation
Up until now, and over many years,
primary care and social services to provide where the ‘strong focus’ on primary care
hospitals have had to cope with some
good patient-centred continuity of care happens at the expense of hospitals,
policy-making shortcomings, including the
is the best approach for keeping people and the likely outcome would be an even
short-termism driven by election cycles,
out of hospital. In short, a well-functioning tighter bottleneck to accessing non-acute
which has tended to see attempts to fix
primary care service depends on well- hospital care, which in turn would create
complex issues with narrowly focused and
functioning, accessible hospitals to succeed greater pressure on primary care and,
simplistic ‘solutions’.
in the overall goal of health improvement. eventually, acute services.
Three significant events this year will
The increasing dependence on To avoid this, both primary care and
determine whether things might change
multidisciplinary teamwork and the hospital care services require significant
for the better:
growing complexity of illness with an boosts in investment.
• the release of the Health and Disability ageing population also require additional
time for collaboration between health THE GENERAL ELECTION
System Review report
professionals, especially between primary Despite hospital wards bursting at the
• the Budget
care practitioners and hospital specialists. seams and staff struggling to cope
• the general election. This requires workforce shortages to be with growing workloads, health is not
addressed. considered a top election issue for most
HEALTH AND DISABILITY SYSTEM
political commentators who have so far
REVIEW These are some of the key issues ASMS
expressed their views on the matter.
has been advocating for and wants
David Clark has stressed the review would Opinion polls commissioned by various
to see recognised in the Review’s
include “a strong focus on primary and independent organisations, however,
recommendations, which are to be
community-based care. We want to make indicate a tight race where any number of
delivered to the Government by 31 March.
sure people get the health care they need to single issues that may emerge during the
stay well. Early intervention and prevention THE BUDGET year could affect the election outcome.
work can also help take pressure off our
While the Health and Disability System The recommendation of the Health
hospitals and specialist services.”
Review is reportedly not about fixing and Disability System Review, the
The same idea is pushed in the Review’s today’s problems tomorrow, but rather Government’s response, Vote Health, and
Interim Report, released last year, that considering what is needed over the the ensuing public debates on them all will
we must shift “away from a treatment longer term, the timing of the final report’s be critical factors in determining whether
focus towards a prevention focus”. Such release suggests there could well be some health becomes a deciding issue in this
thinking, however, fails to recognise the recommendations that have implications year’s election.
WWW.ASMS.ORG.NZ | THE SPECIALIST 15Dr Freebairn with the mother of a child with measles L–R: Dr Chris Poynter, Dr Ross Freebairn,
at Tupua Tamasese Meaole Hospital Dr Leinani Aiono-Le Tagaloa, Dr Corey Vaea, Dr David Closey
A HELPING HAND IN
THE PACIFIC
ELIZABETH BROWN | SENIOR COMMUNCIATIONS ADVISOR
S amoa’s devastating measles epidemic is no longer headline news, but its impact is etched in the mind of Hawke’s Bay specialist Dr
Ross Freebairn.
The outbreak, which began last October, has number nursing wise, so really it can only Samoa has a population of around
killed 83 people – mostly babies and young run three or four patients at best. When 200,000. For the Hawke’s Bay doctor, that
children. More than 5,600 people were I arrived, there were 12 patients and up put the situation into even sharper focus.
infected, and the country was put under a to 70 paediatric patients being treated
state of emergency for six weeks leading up elsewhere in the hospital, along with six
to Christmas. Schools were closed, travel temporary HDU beds in an AUSMAT tent.
and public gatherings were restricted, and “Samoa’s population is
“The registrars were working 30+ hour
red flags were placed outside the homes of about the size of Hawke’s
shifts, and because it was too far to go
people who hadn’t been vaccinated.
home between shifts, nursing staff were Bay, and to have 80 deaths,
The outbreak was caused by low sleeping in the ICU storeroom”. mainly among children,
vaccination rates, made worse by the
He, along with Dr David Closey would be unthinkable,
tragic deaths of two children in 2018.
(Christchurch), and later with Dr Chris completely devastating”.
The deaths were the result of nurses
Poynter (Auckland) and Dr Leinani
mistakenly mixing the MMR vaccine
Aiono-Le Tagaloa (Middlemore), provided
with a muscle relaxant instead of water,
clinical support in the ICU overnight,
but initially the deaths were blamed Dr Freebairn stresses he was part of
relieving the burden on the sole intensive
on the vaccine itself. That led to local
care and paediatric registrar assigned to a team of New Zealand and overseas
fears around vaccines, which were then
overnight cover. medical professionals who were able to
exploited by anti-vax campaigners.
provide care in a difficult environment.
“One of the things that concerned us is
In early December the epidemic was
that the whole health system had ground “Elizabeth Powell and her team from
at its height. The number of cases was
to a halt. They did no elective surgery. MFAT had arranged for further rotation
spiralling, health services in Samoa
They couldn’t do anything other than fight of nursing and medical staff to relieve us
couldn’t cope, and the call went out for
this stream of children coming in with at the end of rotation, including additional
international assistance.
severe disease”.
staff from Starship and other New
Dr Ross Freebairn, an intensive care
Shortages of staff, medication and medical Zealand hospitals”
specialist from Hawke’s Bay Hospital, was
supplies, along with language barriers,
part of the emergency response team sent He’s relieved that thanks to a huge push,
were also challenging, not to mention the
from New Zealand to help. vaccination rates in Samoa have risen and
heartbreak. The majority of patients and
He says the scale of the outbreak was victims were under two years old. the measles outbreak has slowed markedly.
clear the minute he arrived at Tupua Dr Freebairn believes that supporting
“The ICU was an open unit, so children
Tamasese Meaole Hospital in Apia. our Pacific neighbours is important, and
were dying next to parents who were
“The ICU is supposed to be seven beds sitting with their own seriously ill children. if another crisis arose, he’d be more than
but is only staffed for about half that That was difficult,” says Dr Freebairn. happy to pack his bags.
16 THE SPECIALIST | MARCH 2020TESTING POSITIVE AT
FAMILY PLANNING
LYDIA SCHUMACHER | COMMUNICATIONS ADVISOR
D r Catriona Murray’s patients only see the tip of the iceberg when it comes to her work at family planning. Making this visible to
non-medical colleagues and managers was part of her challenge at recent Family Planning collective negotiations.
Dr Murray works at the Family Planning They’re really experienced but also need For Dr Murray, her first experience of
clinic in central Wellington and in Porirua. doctor support, and we are finding that contract negotiations was an eye-opener,
ASMS has supported Family Planning we aren’t having time to do that as well as and she was surprised to see how many
doctors in reaching a new collective processing our own results and tasks.” people were involved. As someone who
agreement. works closely with Family Planning
Clinical administration is now stated
The growing number of administrative in the new collective agreement as a management as part of her role as
tasks for doctors at Family Planning was critical component of Family Planning Locality Medical Advisor, she also
one of the major issues acknowledged in doctors’ work. There was previously no found it strange sitting across the
the agreement. acknowledgment of it. negotiation table.
Dr Murray says doctors have been Another win out of the negotiations is that “I’m working with the managers who are
concerned about the increasing amount of Family Planning doctors are now entitled then sitting on the opposite side of the
time spent on administration. to five weeks of annual leave after five negotiating table, so for me I was a bit
years of continuous service. conflicted!” she says.
“The patients seen by doctors at Family
Planning have increasingly complex “Increased annual leave has been a “I was really hoping it wasn’t too
needs, and we can spend quite some time priority for our members for ages, and we confrontational, and I was relieved that it
finding out what the issues are, what has are pleased to have made progress on was all done in a very positive way”.
been tried, and chasing the results of this” says Dr Murray.
Dr Murray believes having ASMS speaking
investigations already done.
The extra week brings Family Planning up on behalf of Family Planning was
“Nurses see many of the patients at specialists closer towards the DHB MECA particularly valuable.
Family Planning, and doctors support the standard of six weeks of annual leave.
“To have someone external looking at our
nurses to work at the top of their scope.
pay and conditions, and going ‘actually,
you probably deserve a little bit more’ is
good. It also helps with recruitment and
retention”.
The collective agreement is for 18 months.
Family Planning is negotiating their
contract with the Ministry of Health this
year, with the hope of more funding.
Dr Murray is keen to emphasise the
importance of accessible and equitable
sexual and reproductive health services.
“From a purely financial perspective,
studies have shown that provision of
contraception saves more in public
expenditure for unintended pregnancies
than the cost to provide the contraception.
And, of course, there are also so many
other benefits. We are so happy that the
hormonal intrauterine systems have been
subsidised, but we would love to see more
money for this sector to improve access.”
The bargaining team consisted of
Catriona Murray, Rachel Beresford and
Carol Howell from Family Planning, along
with Sarah Dalton and Miriam Long
Dr Catriona Murray
from ASMS.
WWW.ASMS.ORG.NZ | THE SPECIALIST 17You can also read
