Risks to laboratory services increasing

FROM: Dr Ross Boswell, Chairman NZMA

DATE: Thursday, 5 October 2006

SUBJECT: Risks to laboratory services increasing

The New Zealand Medical Association has given a very strong warning to the Minister of Health regarding its serious concerns about growing threats to the long-term future of laboratory services in New Zealand in the light of DHB reviews around the country.

“Laboratory services are an integral and essential part of a first world health service, and we can’t afford to get it wrong,” said NZMA Chairman Dr Ross Boswell. “At present, the future of laboratory services in New Zealand is uncertain at best.”

Dr Boswell said the “hands-off” approach of the Ministry of Health, which has no policy framework within which DHBs should carry out laboratory reviews, and the fragmented decentralized way the reviews have been happening, pose a number of serious risks:

- There is no safeguard for the national interest, and decisions taken for apparently sound local reasons may have disastrous national consequences.

- A cost reduction approach by deficit-ridden DHBs risks the sacrifice of quality and safety.

- DHBs are introducing different services and standards, meaning there will be inequalities of service for New Zealanders depending on where they live.

- Disrupting their employment situation poses very high risks of alienating an already stretched workforce, and destroying morale. Pathologists and laboratory scientists, who are already in short supply, may choose to go overseas rather than stay and risk an uncertain future.

- Reducing the number of laboratory providers in the community may lead to long-term problems. Who will there be to pick up the pieces if the sole provider to a region fails?

The NZMA believes that the risks of severely damaging the future of our laboratory services are too great to allow the current processes to continue.

We have called for the following actions from the Government:

- Immediately halt the implementation of further change to the laboratory services of New Zealand.

- Take urgent steps to engage all interested parties in developing a national policy framework to govern the provision of laboratory services

- Convene an independent Ministerial review to analyse, and if necessary revisit, the DHB processes and decisions taken to date

- Develop and implement a national plan for the provision of laboratory services

The NZMA's letter to the Minister of Health is attached.

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18 August 2006

Hon Pete Hodgson
Minister of Health
Parliament Building
WELLINGTON

Dear Mr Hodgson

The New Zealand Medical Association has previously brought to your attention our serious concerns about the growing threats to the long-term availability and sustainability of laboratory services in New Zealand. We feel that we must bring this issue to your attention again as the future of these services in New Zealand is now uncertain at best.

High quality pathology laboratory services are an integral and essential part of a first world health service.

Our concern is based on three key and closely related factors:

a. There is a complete absence of a comprehensive national policy
framework for the provision of laboratory services. As a result, DHBs are making critical strategic decisions about services in a policy vacuum, based entirely on local or regional factors and perspectives.

b. There is an over-riding context of trying to find cheaper ways of purchasing laboratory services in order to meet budgetary targets, to the potential detriment of sustainability, quality and safety. There is considerable risk that this drive to cheapness may lead to the penalising of associated clinical services by cost-shifting.

c. National implications for workforce and the long-term sustainability of laboratory services are not being attended to, and there is consequent risk that services may collapse locally or nationally.

Since September 2004 the NZMA has been pressing for the development of a national policy framework within which DHBs could carry out their reviews of laboratory services. When the reviews were conducted without such a framework being developed, we urged the Ministry and yourself as Minister to undertake a national post-review assessment of DHB reviews and decisions, so that a national overview of the decisions and their implications could be obtained. Neither has occurred.

The result has been a fragmented approach by DHBs to their reviews of laboratory services, and to the decision-making processes which have followed. The lack of national policy combined with the quest for cost reduction has resulted in processes and arrangements which involve undue risk by overturning the status quo of established relationships and effective service in favour of unproven and potentially unstable and non-viable arrangements.

We have observed growing public and professional concern regarding the laboratory situation, and we believe that there is considerable risk in implementing major changes to vital health services without the support of the medical profession and the community.

We have seen little evidence of international best practice in terms of either policy considerations, or review and contracting processes. The wide range of methodologies employed along with the diverse and confused outcomes of the review processes must raise serious doubts about the validity of much of the work to date. Our health system needs to be confident that its management and decision-making processes do not result in unforeseen adverse outcomes. Essential health services must not be exposed to avoidable risk.

Overall, a great sense of uncertainty and instability have pervaded the process, with consequent risks particularly for the sustainability of the workforce, which is already under pressure, and which is in great demand internationally. The national workforce implications of local decisions have been ignored.

The NZMA believes that the risks of severely damaging the future of our laboratory services are too great to allow the current processes to continue. The Government also risks a further loss of confidence in the health system generally. We would therefore ask the Government:

a. That an immediate moratorium be placed on the implementation of further change to the laboratory services of New Zealand

b. That urgent steps be taken to engage all interested parties in developing a national policy framework to govern the provision of laboratory services

c. That an independent Ministerial review be undertaken to analyse and, if necessary, revisit the DHB processes and decisions to date

d. That a national plan for the provision of laboratory services be developed and implemented

We believe that there is an urgent need to address these issues, and would be happy to discuss them further with you. To this end we seek to meet with you as soon as possible.

Yours sincerely,

Dr Ross Boswell
Chairman

ENDS