Heather Roy's Diary: The Health of the Hospitals
Heather Roy's Diary
The Health of the Hospitals The hospital system continues to experience considerable difficulties with strike action by different groups - at the time of writing this radiographers are on a 'work to rule', laboratory technicians have rolling stoppages, hospital cleaners are considering striking, and senior doctors around the country are holding stop-work meetings in July to discuss strike action. Running a hospital without specialists is virtually impossible.
In each case the complaints are different, but the atmosphere of discontent is unmistakable. Why are staff so unhappy? To explain it, we should take a close look at junior doctors - who aren't threatening to strike, but whose plight deserves some thought nonetheless.
A problem hospitals face is that they provide a 24/7 service because people don't get sick according to a particular timetable. Unfortunately, the full staffing of junior doctors is based on a 40-hour week - leaving 128 hours a week with hospitals staffed only by a skeleton 'after hours' crew. This obvious weak point in the system should have been addressed long ago - but the 40-hour week mentality is strong at the Health Ministry. Hosts of new initiatives are launched, but if services close up shop at 5pm on Friday beleaguered evening staff aren't helped.
In years gone by, District Health Boards provided 24-hour care by rostering junior doctors for horrendous hours. Many older doctors tell of often working 24 hours or more at a stretch. It is a telling indictment that DHBs allowed these appalling conditions to continue for decades - creating a situation where junior staff were forced to make life or death decisions in a state of extreme sleep deprivation.
While the worst excesses of junior doctor overtime came to an end with a wave of industrial militancy in the late 1980s and early 1990s, junior doctors still work long hours - the young doctor you see at 10.30pm on Saturday has likely been working since 8am. The Government has worsened the situation by splitting DHBs into two arms: Funding and (service) Provider. The history is complicated, and the results disastrous. The two arms work independently, and frequently against each other. Weak points in the system aren't addressed and the new initiatives constantly launched are often, needless to say, 40 hour per week initiatives.
Now another problem is in the mix: staff vacancies. Shortages are such that junior doctors at some DHBs can't get leave and are pressured to work extra evening shifts. There have been revealing exchanges in Parliament on this issue:
Wednesday 27 June Heather Roy: "In respect of hospitals, just how important is Labour's employment law when Hutt District Health Board house surgeons have been told they cannot take any leave, contrary to employment law, because of the house surgeon shortage, and house surgeons at Capital and Coast District Health Board are allowed to take leave but management then directs senior doctors to pressure the house surgeons, again against the law, to cover gaps above and beyond their normal working hours?"
(Health Minister) Hon Pete Hodgson: "Assertions are made easily in the health sector and they come from the opposite side of the House each day, apparently. We now have an assertion of a crisis in one district health board from the National Party, when the facts show that there has been a 78 percent increase in doctors in the last 6 years; it is hard to manufacture a crisis out of that. The member has made a couple of assertions, unsupported by evidence, which may or may not be true. How would I know? All I have to say to the member is that district health boards obey New Zealand law, including New Zealand employment law."
Thursday 28 June (National Health Spokesman) Tony Ryall: "Why is the Government being so evasive about the true level of the junior doctor vacancies in New Zealand, when this leaked memo to all chief executives of district health boards in New Zealand says: 'New Zealand is currently facing a huge shortage of junior doctors, which has been gradually increasing over the last 7 years. As at the 2nd of May the Auckland hospitals had vacancy rates of 18 to 23 percent for house officers in the third quarter, predictions for the fourth quarter vacancies approach 40 to 50 percent, and these numbers are mirrored in some other hospitals throughout New Zealand?'"
(Health Minister) Pete Hodgson: "The fact of the matter is that the number of doctors employed by Waitemata District Health Board, and by other Auckland district health boards-Waitemata is where the problem is thought by some to be most acute-has been rising steadily every year this Government has been in Government, and will continue to rise, including from next Sunday when that district hospital board's funding increases by 8 percent."
The bottom line is that Labour thinks that, by spending money, it is doing its duty - spending money is easy; spending it wisely is more difficult.
Mr Hodgson also began the week claiming that junior doctor vacancies stood at two percent. The next day they stood at five percent - at this rate of increase we can expect there to be no junior doctors left by the end of July. Meanwhile the Resident Doctors' Association tell us that, at some hospitals, there are between 40-50 percent vacancies.
It is working conditions - not money - that cause this problem. Until the Government is prepared to admit the severity of the issue, nothing will change. Junior doctors will continue to move overseas, and the cost of recruiting overseas doctors to replace our own well-trained ones will rise and rise.
Red Tape Test Inches Nearer The entire country is groaning; strangled under a mass of red tape - and, while all political Parties sympathise, the red tape just keeps coming.
Only ACT has done something about it. ACT's Regulatory Responsibility Bill is the legislative equivalent of the Fiscal Responsibility Act, and the Institute of Chartered Accountants says it's the most significant Bill to come before Parliament since 1994 (when the Fiscal Responsibility Act was passed).
ACT's RRB would apply a 'red-tape' test to all new and existing legislation. Basic questions about legislation would have to be asked ... and answered. Questions like: 'what is it for?' 'What's the problem?' 'What's the cost?'
Impacts on property rights, freedom of choice and the right to contract would have to be spelled out. The Bill would make political decision-making more transparent and politicians more accountable.
Rodney had the Bill in the Private Member's Ballot. It was pulled out before Christmas, and Parliament voted on it on Wednesday (June 27) night. The vote was 114 to six to send it to the Commerce Committee for public submissions and consideration. Only the Greens voted against.
It's no mean achievement to produce a Bill of this magnitude - when National was in Government it tried for years but couldn't get a Bill written. It's unheard of for an 'Opposition' Party to gain such support for such a significant Bill. That's what ACT can achieve with just two MPs. Imagine what we could do with a few more!