When Health Minister David Clark was publicly criticised for dropping a requirement of his health ministry to publish the results of a set of narrow and misleading health targets in public hospitals, I defended him.
The Minister’s decision to drop this reporting showed a willingness to engage in a more thoughtful and effective fashion with his portfolio, which included exploring more robust alternatives.
Politically driven targets cause potentially dangerous unintended consequences, especially in an environment of sustained underfunding. They are highly likely to have contributed to some patients going blind while waiting for eyecare appointments. It’s what can happen when DHBs are pressured to put crude surgery volumes ahead of monitoring patients with chronic conditions and necessary clinical follow-ups.
That is the legacy of the previous Government’s targets, particularly those in hospitals, and its overall approach to health. It tacitly encouraged poor decision-making, short-term thinking and, in some cases, neglect. The health system has too many moving parts and complex problems to distill into simplistic widget counts. The damage caused by the rigid application of targets was exacerbated by underfunding and short-staffing.
The false sense of productivity and transparency engendered by the targets (reinforced by financial retrenchment) papered over a workforce staffing crisis and poor service planning (within and between DHBs). It’s easy to see their attraction for publicity-sensitive politicians, so we admired Dr Clark for doing something brave and sensible.
We are less impressed by his attitude to an idea we put forward to combat the crisis in specialist staffing. We believe the specialist workforce is short by about 20 percent, an estimate derived from surveys of clinical leaders around the country. What more damning evidence is required than the shocking 50 percent burnout rate experienced by our highly qualified overworked hospital specialists.
On top of this, about a quarter of the workforce intends to leave DHB employment in the next five years because of a mix of demographics, job dissatisfaction and burnout.
Our union has proposed a safe staffing accord along similar lines to that achieved by nurses as part of their collective agreement settlement last year.
We understand the nurses’ safe staffing accord was both initiated and brokered by Dr Clark, despite reluctance from DHBs. We commended his actions. While it’s early days, it appears to be working. In Southern DHB, which incidentally had the country’s worst eye patient crisis, it has led to 16 extra nurses being employed.
We have suggested something similar for our workforce, but in contrast to his hands-on approach during the nurses’ dispute, Dr Clark’s attitude is non-committal. While the context is a bit different, given Dr Clark was understandably anxious to put an end to industrial action, we believe there is the same need to show leadership. It would be disappointing if he were one of those health ministers (like his predecessor) who only reacted to a workforce crisis when it generates too much industrial noise.
The Minister’s comment to this newspaper that he would consider an accord if the parties agreed on one, but he did not consider it a “silver bullet”, was underwhelming and a failure of imagination.
If enacted, senior doctors will have time to engage in complex service planning and provide leadership and stewardship. It could reduce the impact of adverse events, which cost the health sector millions of dollars and cause harm to patients. The benefits would be improved patient-centred care, improved and timely access to healthcare, and improved financial performance in our DHBs. This was the conclusion of a report jointly develop by us and the DHBs in 2010.
The proposed accord requires no additional funding, nor contractual changes. Instead it would first involve explicitly recognising the precariousness of specialist shortages in DHBs and then requiring DHB bosses to do what they are already contractually obligated to do to fix it through improved recruitment and retention actions.
David Clark has grasped the seriousness of the deterioration through neglect and poor decisions of hospital buildings. He is to be applauded for the steps he has taken so far to help turn this around. But hospital specialist shortages are even more serious. As much as we need better and safer buildings, we need specialists even more. Buildings don’t diagnose, treat or operate on patients and the quality of their bedside manner is unproven.
Our health minister inherited rather than caused this workforce crisis. But the longer he delays championing the solution, the more likely he is to become the problem.