Regulating accountability of senior health bosses

23 December 2016

Should New Zealand look at regulating accountability of senior health bosses?

A call by the head of an inquiry into one of the United Kingdom’s worst hospital scandals for better regulation of senior health managers raises questions about whether something similar should be looked at in New Zealand, says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).

He was commenting on an article in the UK Health Service Journal that the chair of the Mid-Staffordshire public inquiry, Sir Robert Francis QC, has called for senior National Health Service managers to be regulated in the same way as nurses and doctors to ensure public trust and confidence.

The Health Service Journal article requires a subscription to view but the article can be read online at the UK Nursing Times (https://www.nursingtimes.net/news/professional-regulation/robert-francis-calls-for-regulation-of-senior-managers/7013166.article).

ASMS President Dr Hein Stander told delegates at the ASMS Annual Conference in Wellington last month that a Mid-Staffordshire hospital scandal is happening in slow motion in New Zealand, pointing to this country’s high levels of unmet health need and longstanding shortages of specialists in public hospitals (http://www.asms.org.nz/news/asms-news/2016/11/17/mid-staffordshire-hospital-scandal-happening-slow-motion-new-zealand/).

Meanwhile, Ian Powell says the call by Sir Robert for senior managers to be regulated on the same basis as doctors and nurses as part of a reformed regulatory system should prompt some thinking in New Zealand. Given the different structure of our health system, this would include senior bureaucrats in the Ministry of Health and district health boards.

“We need to take a good hard look at how we hold our health decision-makers accountable. At the moment they get off lightly,” he says.

“We’ve got a situation here where senior doctors and other health professionals are subject to very rigorous professional processes designed to ensure patient safety, but the question has to be asked whether the same level of accountability is applied to bureaucrats whose decisions also affect patient safety.

“We’ve had some very tragic situations where people have been harmed as a result of long delays getting treatment, such as the crisis in ophthalmology which has resulted in some people losing their sight. We need to be thinking how to prevent these situations from occurring, and one way might involve regulating the accountability of health bosses.”

He says health bosses have allowed hospital specialists to be over-stretched and struggling to cope in the face of ongoing resourcing constraints and workforce shortages. ASMS research has recorded high levels of burnout (50%) among the surveyed senior medical workforce and also that a quarter of senior doctors and dentists intend to leave either medicine or the district health board they work for in the next five years (http://www.asms.org.nz/wp-content/uploads/2016/08/Tired-worn-out-and-uncertain-burnout-report_166328.pdf and http://www.asms.org.nz/news/asms-news/2016/11/17/significant-number-senior-doctors-intending-leave-next-five-years-survey-finds/).

“This is a damming indictment of the bureaucratic leadership of our health system and increases the risk of permanent harm to patients.

“We need some fresh thinking to tackle these problems in the coming years. Making bureaucrats accountable for their actions may be part of this,” says Mr Powell.

ENDS

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