Heather Roy's Diary

Heather Roy's Diary

Friday 11 November 2005

Today I attended the Armistice Anniversary Ceremony at the National War Memorial. At 11am we remembered the signing of the Armistice at the 11th hour of the 11th day of the 11th month, 1918 that signalled the end of World War I.

It is of course co-incidental that this anniversary fell in the same week as the opening of the 48th Parliament but a timely reminder to an incoming government that the freedoms our servicemen and women fought so hard for should not be taken for granted.

Parliament Resumes

Parliament resumed this week with the accompanying traditional ceremonies at the start of the new Parliamentary term. On Monday all Members of Parliament were "sworn in". Before any member can speak or vote in Parliament they must take the oath of allegiance or affirmation.

This is normally an upbeat ceremony but was this time a sombre occasion due to the sudden death of Green Party co-leader Rod Donald. The swearing in was followed by the election of the speaker. Margaret Wilson was re-elected to the position and then as tradition dictates presented herself to the Governor General at Government House.

On Tuesday we had the State Opening of Parliament. The Governor General summons the MPs from the debating chamber by sending the messenger Black Rod - so named because of the black rod he carries - to knock on the door of the debating chamber and deliver the directive. MPs then file through to the Legislative Council Chamber to hear the "Speech from the Throne", written by the Prime Minister but delivered by the Governor General.

The speech traditionally outlines the government's programme for the next three years. The speech was unremarkable with little detail and no great vision for the future. Next week when the house sits again we will have the Address and Reply debate. This debate lasts for 19 hours and will consist of speeches from all parties in response to the Speech from the throne and will also include the maiden speeches of all new MPs - 4 Labour, 20 National (Anne Tolley, Tau Henare and Eric Roy all gave their maiden speeches when they became MPs previously) and 3 Maori Party.

Delivering Babies

During a recent inquiry into the death of two newborn babies in 2001 and 2003, Wellington Coroner, Garry Evans, was critical of the provision of maternity services for pregnant women. His report noted that maternity services "were not in good shape" and called for an urgent review of the whole system including reintegrating family doctors into maternity services to allow more joint care.

If the coroner's recommendations are to be acted on, then things are going to have to change a great deal because there are now only 20 GPs in the country involved in obstetrics. This is a strange situation given that most readers will have been delivered by their mother's GP.

When talking to older GPs it is common for a gleam to come into their eyes as they talk about their obstetric practice. Some of the old hands talk of the pleasure of having delivered a baby from a woman who they had themselves delivered a generation ago. The late Dr Elder, a distinguished Southland practitioner, had delivered grandchildren of women he had delivered himself.

My own experience is now not typical. My children, born in the 80's and 90's, were all delivered by my GP who worked co-operatively with both hospital and community based midwives. They shared the ante and postnatal care to provide an excellent service.

The retreat of GPs from obstetrics began with Helen Clark's decision to recognise the College of Midwifery. The College had excellent feminist credentials. They lobbied to have the law changed so that midwives could work independently whereas previously they had been required to work under the supervision of a doctor.

The midwives managed to negotiate salaries commensurate with those of doctors - a reimbursement rate of around $120 per hour plus an allowance for mileage. As many attended deliveries lasting up to 36 hours the costs soared and the obstetric budget blew out. To be fair to Helen Clark this was not her intention and she had hoped that the injection of some competition into the system would reduce costs.

The incoming National government toyed rather ineffectually with the system, reducing the rate of reimbursement to $90 per hour but the problems continued. At the time hospital midwives were earning between $15 and $20 per hour so the incentive to establish themselves in private practice was nearly irresistible.

It was this loss of staff from hospital wards that resulted in a declining level of service. In 1996 an attempt was made at reform by introducing the "lead maternity carer" (LMC) system.

This was essentially a voucher for pregnant mothers and they could choose the lead maternity carer they wanted. However the sum of money was fixed and had to be shared if more than one practitioner was involved. Midwives were the favoured LMC and family doctors abandoned obstetric care in their droves leaving women with very little in the way of choice.

This was a commercial model applied to a non-commercial situation. If a midwife gets into difficulties she can call an obstetrician and the obstetrician is ethically and legally bound to take over the care of the patient. If the obstetrician is unhappy with the midwife's actions he/ she has no say over her subsequent practice. Commercial models only apply to a willing-seller, willing buyer situation. The problem was and is that the obstetricians carry the responsibility but have no power.

Health Minister Pete Hodgson has said that the coroners report would be referred to the peri-natal and maternal mortality review committee - a newly convened committee. I hope Minister Hodgson intends giving the committee strong direction to look carefully at the role of family doctors in maternity services. His bottom line should be maximum choice for women resulting in excellent care for both women and their babies. Given the very nature of committees however I suspect there will be a prolonged review with the inevitable consultation resulting in a long report and absolutely no change.

Golden Handshakes

In last weeks diary I quoted the Prime Minister's comments about golden handshakes when she was in Opposition. She promised that Labour would stop the practice, saying: "I've had a gutful. I don't intend, if I'm Prime Minister, to have to sit there and suffer one humiliation after another because of a culture of extravagance, which has been allowed to grow in the public sector. Whatever is in there and hidden, we want out."

I thought it would be interesting to see just how successful Miss Clark had been at eliminating this 'culture of extravagance'. A relatively quick search of media reports since Labour came to power in 1999 revealed the following golden handshakes: -

TVNZ Chief Executive (Ian Fraser) - $420,000

Families Commission Chief Executive (Claire Austen) - $50,000

NZQA Chief Executive (Karen van Rooyen) - $50,000

Labour Department (unnamed senior position) - $160,000

Industry NZ Chief Executive (Neil McKay) - $120,000

NZ Post General Manager (Robert Lake) - $208,858

Auckland DHB Chief Executive (Graeme Edmond) - $30,000

Sport, Fitness and Recreation ITO Chief Executive (Judy Smith) - $50,000

NZ Police Commissioner (Peter Doone) - $137,500

Airways Corporation Legal Counsel (Ezequiel Trumper) - $160,000

Transend Managing Director (Drew Stein) - $80,000

NZ Post Human Resources Manager (Robyn Leeming) - around $150,000

Healthlink South Chief Executive (Jane Parfitt) - $265,000

Victoria University Vice-Chancellor (Michael Irving) - $420,000

Local Government New Zealand Chief Executive (Carol Stigley) - $140,000

I suspect there are many more payouts that could be added to the list. The objection I have is that the taxpayer is footing the bill.

ENDS

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