A Light From The Left

While not generally an enthusiastic supporter of trade unions, I must admit that Association of Salaried Medical Specialists executive director Ian Powell deserves credit this week.

The ASMS is the senior doctors' union, and the battle over senior doctors' pay has gone on now for the best part of two years. The ASMS recently sought - and received - approval from the majority of its members to take strike action.

While this may not seem an unusual step for a union, senior doctors have never taken industrial action before - and although the hospital specialists at Timaru Hospital did strike, this was an isolated incident. A nationwide strike by hospital specialists would be something completely new.

This is a battle that neither side wants to fight. Doctors are encumbered by their professionalism; most simply couldn't walk away from suffering patients, and many would end up working whilst on strike - ending up working unpaid, which would suit the District Health Boards just fine.

Health Minister David Cunliffe, however, doesn't wish to be recorded as the first such Minister to provoke the first ever nationwide strike amongst a traditionally diligent professional group - well, not in election year anyway.

Most of the reporting so far has concentrated on the financial aspects of the disagreement, and this has been part of a larger public relations battle. For example: the DHBs quote senior doctors salaries as being "about $200,000"; meanwhile, the union puts the average closer to $150,000. As this is a matter of verifiable fact, it has to be said that it is the union that has its numbers right.

Given that specialist salaries have fallen far behind Australia, the debate as to whether senior doctors should get a five percent increase is likely to make little difference to recruitment and retention. However the ASMS has extracted an important concession, in that senior doctors will be given time away from patients to help run hospitals in a proposed deal with DHBs. One newspaper reported this as "Doctors offered role in running hospitals".

Mr Powell is quite correct in saying that a change in attitude is needed at a management level. Being side-lined in decision-making has contributed to doctors' estrangement as much as declining pay disparities. This provisional agreement would give senior clinicians more involvement in hospital management and should improve the quality of the decision making. The ASMS is yet to vote on this proposal, but will do so over the next month.

In particular, the involvement in management decisions is the kernel of an excellent idea and akin to something ACT has been proposing for some time.
New Zealand currently has a public health system run by accountants and "professional managers". It would be inconceivable to have a Police Commissioner who has never walked the beat, yet it is considered quite acceptable to have people running our public hospitals who have never spent a night working in the Accident and Emergency Department - let alone anywhere else in the health system treating patients.

Forgotten is the fact that we have a healthcare system that is supposed to treat and cure patients - the unwell - and that treatment and curing is done by health professionals: doctors, nurses, physio's, radiographers etc. Patients and health outcomes should be the top priority. Instead money, rationing, forms in triplicate for the Health Ministry and bureaucrats have become the priority - with patients too often considered a distraction except at the coalface.

ACT wants to see doctors, nurses and other health professionals put in the driving seat when it comes to clinical decision making about their patients care. Ian Powell's idea of greater involvement in management decisions by senior doctors should be embraced as a good starting point and I'd like to go a lot further.

What's wrong with allowing the clinicians to take over their departments - manage and run them in return for greater productivity and reduced waiting lists? Cutting out middle management in this way would significantly improve efficiency and decrease bureaucratic waste. Most health professionals know they're capable of running their departments more efficiently. They know where the waste occurs, where efforts are best focussed and, most importantly, what works best. Sadly they're never empowered to take the lead and get the best quality healthcare, at the best cost, in the best time.

There is one example of this happening - although those involved prefer to keep a low profile. This department was in crisis - constantly overspent, with unacceptably long waiting lists, low productivity and a seriously disaffected workforce. In desperation, the DHB involved handed the running of this unit over to the senior doctors. They developed an informal partnership, making management and financial decisions. Within weeks the waiting lists were under control - quickly getting to zero - productivity skyrocketed and the department came in under budget. This situation remains today with local patients receiving an exceptional service.

Why?

Patients are the priority and those making the clinical "curing" decisions were also making the management decisions. This is what can - and should - be done elsewhere. Maybe with the union on board, this Labour government might even listen.