T H E M AG A Z I N E O F T H E A S S O C I AT I O N O F S A L A R I E D M E D I C A L S P E C I A L I S T S
131 | JUNE 2022
With the arrival of Health New Zealand...
Will we get better?
Inside this issue ISSUE 131 | JUNE 2022
Want to know more? Find our latest resources and information on the ASMS website www.asms.org.nz or follow us on Facebook and Twitter. Also look out for our ASMS Direct email updates. This magazine is published by the Association of Salaried Medical Specialists and distributed by post and email to union members. Executive Director: Sarah Dalton Magazine Editor: Elizabeth Brown Designer: Twofold If you have any feedback on the magazine or contribution ideas, please get in touch at email@example.com.
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THE SPECIALIST | JUNE 2022
Trust and confidence
Taking on the culture of ‘NO’
Beating the drum for our allied health colleagues
Exposing the gaps
Legacy work – leading the Māori Health Authority
Will we get better?
A Budget for the status quo
A union man through and through
Five minutes with Dr Mark Lawrence
Meet our new Policy and Campaigns Researcher
A restorative sabbatical
Asking for medical advice on social media
Did you know?
Beyond the mask
Trust and confidence Dr Julian Vyas | ASMS President
Trust and confidence are critical to the successful function of any organisation. It is vital to the success of Health NZ and the Māori Health Authority that they enjoy the confidence of the public and, just as importantly, their workforces. The pressing need to redress the current, chronic failures of engagement with the health workforce is recognised by the Transition Unit, and the test will be whether this carries over once Health NZ becomes our new employer. Health unions have been highlighting critical staffing shortages for years. When I look back at editions of The Specialist over a decade or more, the same issues are reported time and time again: •
not enough senior dental and medical staff for the workload
managerialism hindering proper distributive clinical leadership
lack of capacity within the hospital estates.
Yet for just as long, there has been a begrudging approach (at best) from DHBs to even acknowledge the evidence, data, and experience ASMS has on these issues. It seems that while the DHBs trust us to make lifechanging decisions on behalf of our patients, when it comes to hearing our workplace concerns, we are viewed as untrustworthy. The DHBs consistently questioned ASMS’ staffing surveys that revealed estimated specialist staffing shortages of around 24%. Covid-19 arrived and suddenly the shortfalls across the entire health workforce were well and truly exposed. So much so that DHBs were forced to contravene the Government’s (red) traffic light rules and request that staff who were close contacts of a Covid-positive person, or even Covid positive themselves, should still come to work if they were ‘well in themselves’ – because of staffing shortfalls. Perversely, I could go to work but not go to Countdown. So, dare I presume that there shall be no further denial of a need to recruit more health care staff – not least, doctors and dentists? Last week’s Budget, and Minister Little’s post-Budget speech, recognised the need for workforce development. However, this appears more focused on community/primary care services. With the Government’s announcement of a special taskforce and national approach to clear patient backlog and assuming identification of unmet need is as successful as it needs to be, it seems inevitable that there will be even greater demand placed upon hospital services. Yet, as ASMS has repeatedly pointed out,
our current member workforce is just not sufficient to support this added need. As Aldous Huxley said: “Facts don’t cease to exist because they are ignored.” To maximise the ability of health staff to deal with current and likely future patient need, Health NZ must not allow a continued ‘blind eye’ to be turned to the needs of the workforce.
It seems that while the DHBs trust us to make life-changing decisions on behalf of our patients, when it comes to hearing our workplace concerns, we are viewed as untrustworthy. Staff must not be permitted to remain as fatigued and as unsupported by the system as they currently are. Clinicians must not be placed in invidious situations of having to ration patient access to health care. (We must not forget that even before Covid, some DHBs had already been using a variety of means to restrict the number of patients on waiting lists at any time). We must be properly consulted with and included in devising solutions to improve the provision of health services. Underpinning all this is the keenly awaited Health Charter. This will set out the expectations for both employer and employees in the new system. It should also reflect what is best practice for an employer in terms of properly engaging, listening to, and supporting its workforce. New Zealand needs to recruit more health care staff. Estimates suggest that by 2030, there will be a global shortfall in health care workers of 18 million. Economic reality is that salaries equivalent to those in other countries (especially Australia) are unlikely to be possible here for several years. Therefore, our health system must create other ‘positive attributes’ and support better staff wellbeing to help attract IMGs and retain the people we already have. All of this comes back to Health NZ needing to regain the trust and confidence of members, by showing that it will properly tackle the existing workplace dysfunctionalities and that it truly values and respects its workers in return. Kia kaha
WWW.ASMS.ORG.NZ | THE SPECIALIST
Taking on the culture of ‘NO’ Sarah Dalton | Executive Director
I recently visited one of our larger hospitals to escalate a number of issues we have been struggling to resolve with senior management. Despite organised, persistent, and intelligent work by our industrial staff and our members, several easily fixed matters have become drawn out, hard to solve thorns in everybody’s side. Why is that the case? Why is it so difficult for hospital middle and senior managers to make the jump from ‘good faith relationship’ to ‘this means paying staff correctly and being open to reviewing past decisions which may have caused disadvantage’?
SDO voice. If you aren’t speaking up, best care is not being planned or provided. If you are not in strategic meetings, new facilities will not be fit for purpose, best appointments will not be made, and decent working conditions for clinical staff will not be prioritised.
I am not completely naïve, although I try to hang on to some optimism. To me, these blocking and stifling attitudes have become quite widespread across the hospitals, to the point that I am prepared to argue that the current system both promotes and relies on this type of negative interaction. It seems the first and final answer to reasonable requests is often ‘NO’.
If you are in a ‘black marks’ workplace, let us know. We can help and won’t step away. Remember too that black marks can be a badge of honour and that saying and doing what is right is generally worth it in the long run.
Will the new system under Health NZ help us to knock down some of these barriers to positive and much needed change? Our early interactions with the Transition Unit and interim Health NZ staff suggest there is a will to do better. Certainly, the Board members of Health NZ and the Māori Health Authority are talking a strong game. The fact they have reached out to the health unions, sought engagement, and responded to our meeting requests, bodes well.
It seems the first and final answer to reasonable requests is often ‘NO’. But we cannot rely on trickle down. The fact remains that many of the people who are currently saying NO as a routine response to reasonable requests and blocking urgently needed corrections to discriminatory pay and conditions arrangements will remain in their positions as we enter this new single-employer era. This offers both challenges and opportunities. Rest assured that should the new walk fail to match the new talk, we will be escalating issues rapidly to ensure fair and equitable terms and conditions are in place. Black marks Another pervasive culture across our hospitals is that stroppy doctors who make too much noise, whether it be about patient safety or unfair salary and remuneration, are issued with a black mark. And the black mark travels around, making sure those difficult doctors don’t get promoted, don’t get asked to meetings, and don’t get a fair go. One of the entitlements we hold most dear in your MECA is its vigorous reinforcement of the importance of SMO/
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A very fond farewell And speaking of long runs, I would like to finish with a few words about our colleague Henry Stubbs, who is retiring this month after 28 years of service to ASMS and members, and after many more years of service to the wider union movement. [see article p14] Many of you will know Henry, but you might not know how many ASMS staff he has educated and supported over the years. I have vivid memories of teaching sessions with Henry when I started in 2015, and I know every staff member has had similar experiences of being taught by Henry, coached and mentored by Henry and, occasionally, told off by Henry! The wonderful thing is, for all his vast knowledge of health, of unions and the work we do, of the ASMS MECA (much of which he wrote) and of problem solving, Henry is still a learner in his work, and happily steps up to the plate when new approaches or information emerges. We wish him the happiest of retirements and know he will be kept busy with his wide circle of family and friends.
I know every staff member has had similar experiences of being taught by Henry, coached and mentored by Henry and, occasionally, told off by Henry! Whāia te mātauranga hei oranga mō koutou. This whakataukī teaches that in a world full of noise and confusion, wisdom and wellbeing will come when we ask questions with a genuine desire to understand the answers. It perfectly sums up Henry’s approach to our work, and his example to us over the years. Tēnā koe, te Rangatira.
Beating the drum for our allied health colleagues When 10,000 allied health staff and PSA union members walked off the job in protest over their stalled pay talks, ASMS was there in support as they marched through Wellington to Parliament. The strike was a clear sign of the frustration felt by so many workers about the attitude DHBs have shown over many years towards pay negotiations in the health sector.
WWW.ASMS.ORG.NZ | THE SPECIALIST
Exposing the gaps Dr Charlotte Chambers | Director of Policy and Research
At the start of the year ASMS wrote an opinion piece saying we have an undeclared health workforce emergency in Aotearoa New Zealand. Never has that been more obvious than in the past few months as you and your colleagues try and deliver care to patients amid massive staffing gaps. While Covid has turned these long-standing workforce gaps into daily headlines, we all know that short staffing woes and the battle to plug holes are nothing new. Earlier this year ASMS surveyed heads of department and clinical directors around the country to gauge staffing levels. We have put together some initial results. The timing of the survey was challenging due to Covid, so a huge thanks to all those who took the time to respond. The survey asked clinical hospital leaders to assess how many full-time specialist positions are needed in their department to provide quality and timely patient care. As a result, they provide us with extremely valuable information on how services are faring, and which are consistently struggling with staffing shortfalls. They also enable us to estimate an average nationwide FTE need for specialist services. The results from the survey were fairly consistent with previous work but at the time of writing, not all DHBs had provided lists of CDs and we are working on gathering the outstanding data. However unsurprisingly, many DHBs reported significant staffing shortfalls far in excess of advertised vacancies. The overall estimate of staffing shortfall was 22% based on an average response rate of approximately 50%. In some DHBs the shortfalls were very significant, for example Wairarapa DHB, where it is estimated more than
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50% more SMO FTE are required just to keep up with demand. While staffing shortfalls were particularly acute in small DHBs, some services in larger metropolitan areas also reported notable need for additional staff. Many clinical directors expressed difficulties covering short-term sick leave and annual leave, finding time to commit to training and education duties, and significant issues finding locums to fill gaps and provide cover, particularly in regional hospitals. Overall analysis also found consistent patterns of shortfall by service. Radiology was one service which consistently reported significant staffing need. Recruitment The survey also asked questions regarding ease of recruitment. Many respondents noted the impact of Covid in terms of border restrictions and the challenges of bringing in international medical graduates. Others raised concerns with the training pipeline and commented on difficulties with finding any New Zealand trained applicants for specialty roles. Common reasons for recruitment difficulties included geographical location, visa and immigration issues, salary and better offers elsewhere. While responses differed by geographical location, the findings suggest that there are common problems that need urgent attention from the new Health NZ.
STAFFING SHORTFALL BY DHB (FTE, % FTE) Wairarapa
Waikato Hutt Valley
“Demand consisten tly outstrips supply especially ambulatory/outpat ient care. Could easily fully employ 2-3 more FTE to accom modate demand”
“If we had an a FTE I ddit think ional we w a mu 1.5 o uld b ch b e e in tter prov posit iding ion fo gold r qualit stan y of c d a a rd re an band d width for s qualit ub st y imp antia rovem and l ent w supe rvisi ork on of train ing”
ns licatio Z app N o n s of d round “We ha w e f t f our e las e. All o n o for th t o N . from itment e b een v recru a h s ging t hire coura n recen e k in d. I th aller at sm ab roa k o o l es to elp” traine ould h w s e r cent
“If we could recruit to our budgeted FTE this would be very satisfactory, however our main challenge now is recruitment of suitably qualified and experienced candidates. We have not had any NZ-trained radiologists apply for an SMO position since I was hired in 2019”
ASMS will be reporting in detail to members across each hospital/service on the findings from these surveys once we collate more data, as well as making recommendations to Health NZ.
WWW.ASMS.ORG.NZ | THE SPECIALIST
Legacy work – leading the Māori Health Authority Elizabeth Brown | Senior Communications Advisor
Going back through the generations in Riana Manuel’s husband’s family, you won’t find a man who has lived much past 50 due to cardiovascular disease and decades of poor health. It is that kind of statistic that lies at the heart of health inequity for Māori and one that the head of the new Māori Health Authority/Te Mana Hauora Māori is out to change. Riana (Ngāti Pūkenga, Ngāti Maru and Ngāti Kahungunu) describes her new role and what the Māori Health Authority is about to embark on, as legacy work.
THE SPECIALIST | JUNE 2022
“The aim is to save lives of people who don’t necessarily need to die seven years before others in their communities,” she says. Riana has seen the health system through several lenses. She trained and worked for many years as a nurse. More recently she led Te Korowai Hauora o Hauraki and the Hauraki Primary Health Organisation.
“I’ve seen many different systems come and go during my time in health. In my career this will be the last time we get a major reform. The Government has made a very bold decision to create the Māori Health Authority and I thought this is the system change I want to be part of.”
“We need to make sure we put the best opportunities forward for young people so when they become adults, they are not going to be fighting the big fights we’re fighting now.”
Keeping it local She’s also a firm believer in locally driven health care based on her experience in Hauraki, seeing how effective it can be when Māori health workers design and provide care for their communities. “It’s a model driven by the aspirations of the people who it seeks to serve, and as a result it delivers a good service. That’s what I want to bring nationally.”
“The Government has made a very bold decision to create the Māori Health Authority and I thought this is the system change I want to be part of.” If you live in the Hauraki region, you will still see her out at weekends administering Covid tests. She also still does the odd shift at her small familyowned rest home and hospital in Coromandel. Asked whether there is a conflict of interest over that, she says it’s something she declared when she took on her new role, and she’s confident there is no risk of crossover in terms of funding pathways. So far Riana’s top priority has been the Pae Ora legislation, which will formalise both the Māori Health Authority and Health NZ so they are ready to go on 1 July. Putting in place concrete milestones and markers will be an early next step. As an example, she gives increasing self-screening for cervical cancer for Māori women, which can have an enormous impact on lives saved. “Increasing screening, improving access, and applying a clinical judgement that is driven towards that key population which is underserved – that’s a milestone that you can tick off and show transformation over time. People won’t tolerate not being able to see the difference being made,” she says. Mokopuna pae ora As a proud grandmother to 12 mokopuna, an important personal plank of Riana’s is mokopuna pae ora – making decisions to build the life and world we want for our grandchildren. “We need to make sure we put the best opportunities forward for young people so when they become adults, they are not going to be fighting the big fights we’re fighting now.” According to Riana, social determinants are everything in health because “they are the things that will move the needle on equity”. “Wellbeing is not the absence of disease,” she says.
“It’s about making sure we have a strong economy for our people, that everyone has a job, a home, and people have great educational opportunities. It’s about being strategic and looking at these problems from all directions – that’s the opportunity here.” Political football The Māori Health Authority has already turned into a political football and has found itself at the centre of the co-governance debate. Both the National and ACT parties have said they would scrap it. Riana acknowledges the political aspect to her job but isn’t fazed. “I take hope that we are really starting to discuss our history and co-governance arrangements after 182 years. It’s an important conversation to have because then we can understand why we need co-governance, why we should honour the Treaty and why we need to understand the difference between tangata Tiriti and tangata whenua.” She is keen to see urgent work get underway on a doctor training pipeline to ease staffing shortages and increase opportunities for Māori trainees. “We need more clinicians full stop, but it’s not an overnight solution – it’s a pipeline so we need to start now.” As a nurse she’s aware of the pressures the workforce is under and gives a huge mihi to specialists, who she says do an amazing job.
“I take hope that we are really starting to discuss our history and co-governance arrangements after 182 years.” Riana says working collectively will be key to the success of Health NZ and the Māori Health Authority. “Every opportunity in the reformed health system should be geared towards ensuring that people get the right services in a timely fashion and that we take care of our workforce.” Riana will be based in Auckland alongside Health NZ chief executive Margie Apa, with whom she shares a close working relationship, but will be in Wellington regularly. She will also be heading home to the Coromandel as often as she can and plans to continue her frontline mahi to keep up her practising certificate. More importantly, in terms of her role as head of the Māori Health Authority, she wants to ensure she stays relevant as she forges a new path for Māori health in Aotearoa.
WWW.ASMS.ORG.NZ | THE SPECIALIST
Will we get better? Andrew Chick | Senior Communications Advisor
The arrival of Health New Zealand and the Māori Health Authority on 1 July will mark the most significant change to our health system in a generation. It has been hailed by the Government as an opportunity to tackle persistent health inequities and help end the so-called postcode lottery in terms of access to healthcare. Much of the political debate about the new system has been tied up in arguments about levels of bureaucracy, poor timing, and separatism. But what about the ‘health’ of the system itself? We have taken some key indictors or benchmarks to create a visual series, highlighting some of the problems the system must improve on if the health reforms are to be judged a success. In the coming months and years, the measure of Health New Zealand and the Māori Health Authority will become clearer. But the overall question must continue to be #willwegetbetter? If you would like any of these pictures as largersized posters to put around your worksites, please contact Andrew Chick (Andrew.email@example.com). Also keep an eye out for them on our social media accounts and please like or share them.
THE SPECIALIST | JUNE 2022
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A Budget for the status quo Lyndon Keene | Health Policy Analyst
Before this year’s Budget was announced, ASMS estimated that well over $2 billion of additional health funding would be needed for the coming year just to maintain current service levels and pay for new initiatives.
The additional funding is needed to cover costs such as inflation, wage growth, pay equity agreements, demographic changes, lockdown service backlogs, new initiatives and addressing base funding shortfalls indicated by a decade of DHB deficits.
across-the-board staff shortages
lack of general hospital beds
more than 40% of adults have an unmet need for dental care due to cost
In addition, there are long-standing issues to be addressed, including:
poor access to publicly funded medicines when matched with comparable countries
an estimated 450,000 people with unmet need for hospital treatment
poor cancer survival rates when matched with comparable countries
a further lockdown backlog of patients needing treatment
high levels of potentially avoidable hospitalisation rates
an estimated 1.2 million adults with one or more types of unmet need for primary care
dilapidated hospital buildings and equipment.
health inequity, with significant gaps in life expectancy and other key health status indicators, by ethnicity and deprivation level
overwhelmed specialist mental health and addiction services
overwhelmed emergency departments
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New funding On Budget Day, Vote Health received $1.8 billion of additional funding for 2022/23, but more is to be added to cover the costs of pay equity agreements as they were approved by Cabinet during the course of the year. Broadly speaking, aside from a few areas targeted for new funding, this looks like a status quo budget.
The specific areas that received additional funding should see at least some first steps to improvement, but in many cases, they may be barely discernible.
The Mental Health Commission welcomed the increases but warned that “[with] the system still under extreme pressure, more is needed”.
Broadly speaking, aside from a few areas targeted for new funding, this looks like a status quo budget.
‘Health workforce development’ (not necessarily new staff) gets $11 million this year, rising to $22 million in four years’ time, targeted to community-based services and mostly for Māori services. There is no recognition of the substantial hospital workforce shortages.
Māori health services, including funding to support the development of the new Māori Health Authority, received $168 million for 2022/23, although only $57 million of that is genuinely new funding – $7 million is an adjustment for inflation and population change. In real terms, then, it is a $50 million increase, amounting to about 0.2% of the total operational budget, excluding Covid-related funding. Additional funding for Pharmac, which was wrongly reported in the media as a “massive” 20% increase, included $71 million for this financial year (6.4% increase) and a further $49 million added to that in 2023/24 (a 4.1% increase on 2022/23 funding). Given domestic inflation is forecast for the next two years at 5.2% and 3.6% respectively, and pharmaceutical cost increases are generally higher, this looks like mostly an adjustment for inflation. Pharmac’s budget bid in 2020/21 suggested an additional $200 million a year was needed to cover cost increases. Addressing the shortcomings identified in the recent Pharmac review will require a greater funding boost. Intensive care units are budgeted with an additional $83 million this year in a curiously termed “proposal” to resource additional critical care beds, rising to $140 million next year. Assuming the proposal becomes reality, this should at least lift New Zealand off the bottom rungs of the OECD rankings for ICU beds per capita, but bear in mind New Zealand has a long way to go to reach even an average OECD ranking. Specialist mental health and addiction (MHA) services get an extra $9.4 million this year (0.5% of the $1.8 billion currently spent on MHA services annually), rising incrementally to $50 million of additional funding in 2025/26 (3% increase). A further $14.3 million of extra funding will go to expanding support for children, rising to $29 million by 2025/26.
Stretched air and road ambulances receive injections this year of $23 million and $32 million respectively, but this still falls well short of the fully funded model that has been called for in a public campaign. Big ticket items Years of under-investment in health infrastructure led to a $14 billion fix-it bill in 2018. Budget 2022 provides $1.3 billion over four years in capital funding for health infrastructure, which will support both the delivery of new infrastructure projects and preparatory work on other projects. Regardless of what happens in the health system, the growing rates of health service need above population growth rates are likely to continue while many New Zealanders remain living in poverty. Suffice to say the Salvation Army was “underwhelmed” by this Budget, giving it a six out of ten. So, while the additional $1.8 billion in this year’s health budget (with more to come) is a hefty sum, it needed to be to cover some particularly big-ticket items, including high inflation, large pay equity settlements and neutralising historical debts. Despite the funding boost, it will not on its own provide much relief from the main long-standing pressures on the system and those being experienced by frontline staff. Several very substantial health budgets will be needed to do that in the coming years.
Despite the funding boost, it will not on its own provide much relief from the main long-standing pressures on the system and those being experienced by frontline staff.
WWW.ASMS.ORG.NZ | THE SPECIALIST
Henry with his trademark braces
A union man through and through Elizabeth Brown | Senior Communications Advisor
When Senior Industrial Officer Henry Stubbs retires this month, not only will it end his 28 years at ASMS, it will also bookend a near lifetime career of unionism. Henry started with ASMS in 1994, just a few years after it was founded, becoming its first ever industrial officer. In the years since, he has supported hundreds of ASMS members and been integral to the growth of the union, not to mention a wise and generous colleague to ASMS staff through the years. Henry came to ASMS with strong union credentials. As a young man he abandoned a law degree to become a full-time Wellington bus driver. Against the grain of his conservative National Party family, he joined the Tramways Union, moving up the ranks to become President of the Wellington branch and then its National Secretary. With an office in Wellington’s Trades Hall, Henry was lucky to escape the 1984 bombing that killed cleaner Ernie Abbott. “The bomb was in an old-styled school case and sat outside my office all day on the ground floor until five o’clock, when unfortunately, Ernie picked it up. I had been in a meeting down the hall with several others and we had left the building about 15 minutes before the blast.” In the late 1980s Henry went back to university to finish his law degree. Keen to support the fight-back against the introduction of the union-busting Employment Contracts Act (ECA), he joined the insurance and bank workers’ union FINSEC as its Central Regional Secretary.
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An ideal fit In 1994 an ad for a foundation industrial officer at ASMS caught his eye. Armed with a reference from Council of Trade Unions President Ken Douglas, Henry saw it as an ideal fit. “They wanted someone who was legally qualified, which I was; they wanted someone with union experience, which I had a great deal of; and as a bonus my father and both grandfathers were doctors, so I was familiar with the medical community and the system.” At the time ASMS had 1,400 members. Led by Executive Director Ian Powell, Henry says the focus was to build union membership and finances and show that ASMS was “here to stay”. At the time, many unions were being destroyed and the unionised workforce fell from 80% to well below 50%. “The health sector was completely shaken up by the so-called health reforms which had grown out of the neo-liberal economic and political order that had spawned the ECA. The reforms were predicated on the belief that if you turned health into a competitive market, it would be cheaper,” says Henry. Despite the political climate, collective agreements were negotiated for ASMS members in most of the 23 market-
driven Crown Health Enterprises. The way was also paved for job-sizing, and payments for after hours and on call. Salaries for ASMS members grew significantly, which in turn encouraged recruitment and growth. Henry was busy.
“Henry has always been a great advocate for working people. He has real skills at working on personal cases because he is empathetic, listens, and does the right thing by people.”
“The overwhelming majority of doctors knew they’d been badly treated, they knew they were underpaid, they knew they were overworked, and they were crying out for a bunch of professional skilful people through the union to negotiate on their behalf, represent them and enforce the contracts and agreements they had entered into.”
As Henry looks back on his lengthy career, he has been disturbed to witness rising job stress and burnout among members, and the lack of action from health management.
Henry is most proud of his work helping people through employment disputes, particularly the development of Clause 42 in the MECA, which covers investigations of clinical practice. “I’ve enjoyed working with lawyers to ensure that whatever concerns are raised about a member that they are investigated fairly and properly with the least disruption to a person’s clinical practice and least damage to their professional reputation. It’s important.” An empathetic advocate Former National Executive and honorary lifetime member Dr Judy Bent got to know Henry in 1997 through her work on the National Executive and ongoing issues at the Auckland District Health Board. What stood out were his reasoning and analytical skills and his unwavering support of members.
“Henry has always been a great advocate for working people.” “Henry was deeply committed to supporting individuals but wouldn’t let the wool be pulled over his eyes. He could get to the nub of issues very quickly and solve problems.” “He dealt with everyone in a calm and reasonable manner and was the soul of discretion,” she adds. Long-time and well-known Wellington trade unionist Paul Tolich, who has known ‘Stubbsie’ since the 1970s, is also full of praise.
“If you exhaust doctors, if you don’t respond to the endless signs that they are working under stress, then you are complicit when they fall over.” “My colleagues and I are finding it very frustrating dealing with people who should have been supported two, three, four years earlier and with a little more care can be rehabilitated to go on and continue their careers with pleasure and to the benefit of everyone.”
“A number of our members have probably found me a sometimes interesting and sometimes difficult character to deal with … because I can be a bit direct and a bit blunt.” Self-reflecting on his 28 years at ASMS, Henry says, “A number of our members have probably found me a sometimes interesting and sometimes difficult character to deal with because I understand I have my idiosyncrasies and I can be a bit direct and a bit blunt.” “But I come from a medical family, I know doctors, I’ve seen the pressures they work under so my task has been to help them solve their problems and that’s what I’ve enjoyed doing.” Now 71, Henry is ready to embrace retirement, although he will miss the social and collegial aspects of working. Henry is being farewelled by members, former members, and his ASMS and union colleagues at a special function later this month before he formally leaves the building on 30 June. Go well Henry!
Henry starting as ASMS’ first industrial officer in 1994
WWW.ASMS.ORG.NZ | THE SPECIALIST
Mark tramping with his whānau in the Routeburn Valley
Dr Mark Lawrence
We introduced you briefly to Dr Mark Lawrence (Te Rarawa, Te Aupōuri, Ngā Puhi) in the last edition of The Specialist as our newest National Executive member. Mark is a psychiatrist in the Bay of Plenty. We asked him to share a bit more about himself. What inspired you to get into your field of medicine? I always wanted to be a PE teacher, so I completed an undergraduate degree in Physical Education at the University of Otago. In my last year I decided to apply for medicine through the postgraduate Māori pathway, initially with a view to doing orthopaedics or sports medicine. I worked at Tauranga Hospital as a junior house surgeon, where there was excellent advocacy for more Māori considering psychiatry along with active support for Te ORA Māori Medical Practitioners. Legends in the field included Dr Henry Rongomau Bennett, Tā Mason Durie, Dr Erihana Ryan, and Dr Rees Tapsell to name a few. There was also a strong cohort of young Māori doctors keen to pursue psychiatry at the time, such as Dr Hinemoa Elder, Dr Cameron Lacey, and Dr Thomas Rickard. My fellow junior house surgeon Dr Donna Clarke and I both joined this group. At the time the Ministry of Health supported a scholarship programme which was effective in recruiting more Māori trainees into psychiatry. It provided leadership, mentorship, cultural supervision, and financial support for educational purposes. The rest is history. I would not have survived without this amazing programme. Lastly, I was also concerned about the high rates of mental health problems in Māori so wanted to work in a field of need. I have never looked back! What are some of the challenging aspects of your job? One of the biggest challenges of working in psychological health is differentiating normal emotional or psychological response from pathological response to a given
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circumstance. The threshold between normal and abnormal can be quite blurred at times. He mana tō te kupu! Words have power! The ability to formulate a person’s problem(s) is the art of psychiatry, and the ability to articulate these issues back to the person takes skill. Psychiatry also sits between the interface of respecting the rights of free will/choice and the application of compulsive assessment/ treatments when legal definitions of disorder are met. Applying the Mental Health Act to someone who lacks capacity is often a vexing predicament. The other major challenge is trying to address mental health concerns and presentations precipitated by the social determinants of health. Depression caused by stress of poverty, homelessness and challenging life experiences may respond better to addressing the drivers rather than adding an antidepressant. The health sector has a role in driving social policy and advocacy for our vulnerable populations. What do you find rewarding about your job? The flexibility to engage in a range of different roles and understanding that learning is a lifetime journey, not a destination. Psychiatry rewards me with this endeavour. I am one member of our Outpatient Community Adult Team (Clinical). I have an academic role (University of Auckland School of Medicine) with teaching and examining fifth year and trainee interns. I am also on the Board for RANZCP. Despite what the media says, most people do improve and have a good journey through mental health services when they can access
them. Unfortunately, there is often too much focus on the negative experiences people have. There are some amazing people working in mental health. I do like connecting with people and making a difference to their lives and their whānau. Psychiatry is one of the few specialities that treats the whole person rather than just a collection of symptoms. As people exist in complex biopsycho-social-cultural systems, therefore the solutions go beyond medication alone. What do you see as the biggest challenge facing the health system? Where do I start? He aha te mea nui o te ao? He tāngata, he tāngata, he tāngata! What is the most important thing in this world? It is people, it is people, it is people! In health, workforce investment and maintenance are the key to a successful health care system which has limited budgets. We need to invest in the workforce that calls Aotearoa home. I have seen many colleagues go to Australia because of conditions and remuneration. Our workforce is tired, stressed and at times feels undervalued. My biggest challenge with my on-call duties is finding a bed for the acutely unwell. We simply do not have enough beds. This means we must find other solutions, which is often not safe for the person and
then puts clinicians at risk of adverse outcomes. Greater investment in infrastructure to match population growth and demand is desperately needed. What keeps you happy outside of work? Exercise the tinana (run, walk, tramping, cycling, swim), listening to my favourite podcast and music, learning te reo Māori, whānau time, travel and exploring new places. I try to do something active every day usually before and after work. Kapa haka group at our local hospital refuels my wairua! Why did you want to be involved with ASMS? I attended my first ASMS hui in 2020 in Pōneke. I really enjoyed the collegiality and connection with some really engaging members who were strong advocates for its membership. I had worked with Henry Stubbs on a local issue in Tauranga and was impressed with his skills and expertise in managing a complex situation and wanted to give back to ASMS. I was also impressed with former National Executive member Dr Paul Wilson’s contribution and encouragement to join. Having a diverse membership at the executive level of ASMS is important and I felt I would offer another dimension.
Meet our new Policy and Campaigns Researcher Tēnā koutou Ko Maungawhau te Maunga e rū nei taku ngākau Ko Waitematā te Moana e mahea nei aku māharahara Nō Tāmaki Makaurau ahau. E mihi ana ki ngā tohu o nehe, o Te Whanganui-aTara e noho nei au. Ko Harriet Wild toko ingoa. Nō reira, tēnā koutou, tēnā koutou katoa. Maungawhau/Mount Eden is the mountain that speaks to my heart The Waitematā Harbour alleviates my worries I am from Tāmaki Makaurau/Auckland. I recognise the ancestral and spiritual landmarks of Te Whanganui-a-Tara / the Wellington Region where I now live. My name is Harriet Wild. I have joined ASMS as the Policy and Campaigns Researcher after more than eight years at the Royal Australasian College of Physicians (RACP). For most
of that time I was leading the College’s Policy, Advocacy and Māori Health Equity activities in Aotearoa New Zealand in partnership with Fellows and trainees. This included the RACP’s social determinants and health equity campaign #MakeItTheNorm, which focused on the need for healthy housing, good work, whānau wellbeing and equitable outcomes. I was the lead policy advisor to the Māori Health Committee, which was gaining prominence in the College through the development and implementation of the RACP Indigenous Strategic Framework 2018– 2028 and greater emphasis on Te Tiriti o Waitangi, anti-racism, and decolonisation in the RACP in Aotearoa New Zealand and in Australia. My academic background is a little different from most policy folks. I have a Bachelor of Fine Arts from the Elam School of Fine Arts, and a Master of Arts (First Class Honours) from the University of Auckland. My research interests in my painting practice include both figurative and abstraction – mainly in watercolour. I am looking forward to meeting ASMS members in my role and advocating on behalf of the profession.
WWW.ASMS.ORG.NZ | THE SPECIALIST
Patient solidarity Elizabeth Brown | Senior Communications Advisor
Dr Anna Elinder-Camburn can relate to her patients on a whole new level after having her head shaved to raise money for Leukaemia and Blood Cancer New Zealand. The Auckland haematologist, who works at North Shore Hospital, cares for patients with blood and bone marrow cancers such as leukaemia and lymphoma. As a result, Leukaemia and Blood Cancer NZ’s Shave for a Cure fundraiser is very close to her heart. “Working as a haematologist, I am reminded on a daily basis of the ongoing need for further developments in the field for those who are less fortunate, and I also want to help make sure people with cancer get the support they need,” she says. There were also personal reasons. “Ten years ago, the son of my cousin was diagnosed with acute lymphoblastic leukaemia (ALL). He is now in remission, and I am forever grateful for the research and scientific discoveries that enabled his cure. I have worked as a haematologist for over ten years and have seen the good, the bad and the very sad, along with the success stories. My work is an absolute privilege and it felt like the time was right to give something back.”
Positive reaction Anna says the reaction to her new look has been overwhelmingly positive from both patients and colleagues. “I have been told I’m brave, and colleagues have thanked me for raising both money and awareness.” “I’ve had patients email me and have also had patients in clinic saying, ‘Doc, that was awesome.’ It has led to some conversations with patients becoming slightly lighter and it has been quite a good icebreaker.”
“I’ve had patients email me and have also had patients in clinic saying, ‘Doc, that was awesome.’”
Anna’s 18-year-old daughter Matilda took the plunge as well, and together they have raised a whopping $10,000.
Anna admits looking in the mirror and seeing the contrast was initially quite confronting, but she has absolutely no regrets.
To make the whole experience even more poignant, Anna had her head shaved by one of her former patients, David Downs, who wrote the book A Touch of Cancer.
“I didn’t get a number zero, so still had some ‘scalp cover’, and I acknowledge that it is much tougher for patients who lose their hair to chemo as they lose all hair, including their eyebrows. They also can’t grow their hair back until they finish treatment, so I feel I did a ‘shave light’.”
With David wielding the clippers, Anna made sure her own hairdresser was on hand. “I have to confess I had spoken to my hairdresser about doing this for some time, and when David asked
Matilda and Anna before
if he could shave my hair, I did say I also wanted my hairdresser on site.”
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As a bonus, Anna was pleased that Matilda’s hair, which was long and had never been coloured, was able to be donated to make wigs.
Matilda and Anna after
A restorative sabbatical Dr Katie Ben | Nelson anaesthetist and ASMS National Executive member
The ASMS MECA allows all senior medical officers to apply for a sabbatical of three months paid leave every six years for the purposes of “strengthening or acquiring clinical knowledge or skills or undertaking an approved course of study or research in matters relevant to their clinical practice”. Historically, many SMOs have taken this opportunity and combined it with overseas travel, benefitting from both the travel experience and the exposure to clinical expertise in other major centres. With travel curtailed by Covid-19, I decided to apply for sabbatical leave to allow me some time without the stress of a call roster to write up my master’s thesis. When my application was assessed, the sabbatical committee emphasised the need for my project to benefit the DHB and asked how I was going to pass on my learning to colleagues. (NB: this is not a requirement under the MECA). My thesis subject related to the rationing of health care with a focus on ventilation and ICU access during a global pandemic. I felt it was particularly relevant. However, with no new skill, technique, or practice improvement as an expected outcome, it was a more difficult interview than I had expected. I had managed a postgraduate diploma in Bioethics and Health Law during the previous two years as a distance student through the University of Otago. However, it had required a fair amount of juggling non-clinical sessions, flexibility from colleagues, and most of my CME funding and hours to make it work.
and acute ward patients (with no registrar for assistance), and away from the day-to-day clinical workload. After the first two or three weeks my sleep pattern settled to something slightly more regular, and I developed a routine of working while my two boys were at school. Relaxed and recharged
The researching, reading, and fun of writing a 27,000-word essay transformed me – I was relaxed, I had space to breathe and think, and I could cope easily with spontaneity and change (this is huge for an anaesthetist, trust me). Although it seemed a long stretch of time at the start, the three months and two extra weeks of annual leave I added to the end went too quickly. My thesis was researched, written, and submitted, and I had to return to work. Ironically, I was only back at work for a week before my son brought Covid home from school.
It has given me renewed resilience, a better work–life relationship, allowed me to be fully present at both work and home, and filled me with enthusiasm.
More time less stress To do the master’s research and the writing required more time, more sleep, and less stress, so the sabbatical was an ideal option. I was able to organise online meetings with supervisors, make phone calls during the working day to sort out library issues, and had enough time to read all the papers, articles, and book chapters needed. I also had enough time to work out how to use EndNote – which, if anyone is thinking of any form of essay-based study, is an absolute game-changer!
The researching, reading, and the fun of hme from a grumpy old anaesthetist into a person I almost didn’t recognise. My days weren’t all spent stuck to a computer screen. I used some of my time away from work to recharge the mental and physical batteries which had been depleted during Covid-19 lockdowns, along with the stresses of coping with elective throughputs, call rosters, Covidscenario planning, and replanning. I was away from the hospital, away from the stress of being on call as the single anaesthetist to cover maternity, ICU, theatres, ED,
What surprised me on my return to work was discovering how fatiguing our normal working week is. It had taken me three weeks at the beginning of my sabbatical to catch up on a decade of disrupted and variable sleep patterns, which I mostly ascribed to having worked a demanding on-call roster for my entire clinical career. My first week back I was surprised by how tired I was after a ‘standard’ 10-hour day. I would recommend a sabbatical to anyone and everyone. It is a hugely valuable part of our MECA, with many more benefits than the obvious learning new things or consolidating existing knowledge. Having me at home for three months has been hugely beneficial for my family, and I have re-evaluated my priorities as a result. It has given me renewed resilience, a better work–life relationship, allowed me to be fully present at both work and home, and filled me with enthusiasm. I now have the drive to implement ideas that I think can improve patient care, patient pathways, and patient outcomes. If that isn’t a benefit to the DHB, I don’t know what is. WWW.ASMS.ORG.NZ | THE SPECIALIST
Fighting for safe and sustainable shift work in EDs Nationally the Ministry of Health and DHBs in bargaining have repeatedly failed to deliver national solutions to ensure emergency department shift work is safe, sustainable, and fairly recognised. Given this national inaction, ASMS has been forced to design its own strategy to lift rates and conditions. This has seen us build a national strategy which involves going service to service to negotiate local enhancements based on MECA compliance and a nationally established benchmark. This year we have ink dried on two agreements, a handful at the negotiation stage, and are scoping others. Each agreement is tailored to the local setting, but we have negotiated on issues including enhanced locum rates, fair recognition for working short staffed, an increase in non-clinical time, a decrease in weekends, and shift recognition pay to achieve national parity. In several cases, we have also secured commitments to review staffing levels. We are very aware of how tough ED work is at present and with what already looks to be a very difficult winter ahead, we are actively committed to getting improvements service by service.
The future of JCCs
Sharing our research ASMS Head of Policy and Research Dr Charlotte Chambers speaking at the 2022 Royal Australasian College of Physicians conference in Melbourne on gender equity in medicine. The theme of the conference was A Climate for Change. Charlotte says it was heartening to hear many established clinicians and academic medical professors speak about the need for medicine to adapt to the times, whether it be the changes forced through the Covid pandemic such as adoption of digital technologies, or through the wider adoption of part-time training opportunities.
ASMS has had initial discussions with Health NZ about how we operate JCC meetings in the new health structure. The ability to hold local meetings with members and hospital management is very important. They were established as part of the DHB-ASMS MECA, and we are committed to ensuring they continue. So, look out for a notice about your next local JCC, which will happen sometime between August and October. ASMS is also in discussions with Health NZ about a plan to meet regularly with the new regional leads in the new system, along with national leadership.
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Obstetrics & Gynaecology specialists at Wairarapa Hospital finally have a place to get some much-needed shuteye right outside their back door. With ASMS’ support they have been lobbying the DHB for over a year to get overnight sleeping accommodation close to the ward. The DHB’s initial proposal would have seen facilities on another part of the hospital campus. Members stood firm, saying it would be too far away and there would be safety issues walking back to the ward at night. It was a case of working together to find a solution. The MECA states that employers should provide sufficient good quality overnight accommodation, but we know that in so many DHBs, it is not taken seriously. It is an issue which ASMS will continue to push hospital management on so get in touch if you need support.
Asking for medical advice on social media Dr Chao-Yuan | Medicolegal consultant, Medical Protection Society
There may be times when you have a difficult medical case you would like to seek collegial advice on. With the availability of medical groups on social media, there are now opportunities to access colleagues from different backgrounds and specialties in forums, which often provide a friendly and supportive environment. What are the considerations when asking for medical advice in these forums, and do the Medical Council of New Zealand (MCNZ) and employers have a position on this? MCNZ has published a statement on the use of the internet and electronic communication, which says:
“Consider issues of privacy, security, and sensitivity when you communicate any health information electronically and ensure that you comply with the Health Information Privacy Code 2020. Information on social media can spread quickly and widely. Be careful with the information you share where that can be accessed by any member of the public.” 1
There may be unintended consequences of posting health information on a Facebook page regarding patients. A close relative of the patient might be a member of the group and recognise the case described. Comments might be made that are inadvertently perceived as negative and then shared with the patient. This can lead to potential breach of patient privacy and result in complaints. What if you have patient consent? Consent for such posts on social media can be difficult. This is because Facebook or WhatsApp groups often contain hundreds of members and, although they may be described as a ‘closed group’, they are not secure. Right 6 of the Code of Health and Disability Services Consumers’ Rights states the consumer has the right to be fully informed:
When you discuss consent with a patient, would you be asking for consent to be posting their information on a Facebook page with ‘X’ number of members all from different backgrounds? Would you also be explaining that there is potential for their health information to be shared with individuals outside the group? Informed consent is therefore difficult to achieve. In addition to the Code of Health and Disability Services Consumers’ Rights, Principle 5(b) of the Privacy Act 2020 states:
“An agency that holds personal information must ensure… (b) that, if it is necessary for the information to be given to a person in connection with the provision of a service to the agency, everything reasonably within the power of the agency is done to prevent unauthorised use or unauthorised disclosure of the information.”3
As a health professional it would be incredibly challenging to fulfil the requirements for the storage and security of health information posted on social media. Once you have some suggested management strategies as advised by a social media group, there may also be obstacles for implementing them. For instance, what if the advice you receive is not recommended in your region, or you are not able to prescribe the treatment?
(1) Every consumer has the right to the information that a reasonable consumer, in that consumer's circumstances, would expect to receive, including… (b) an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option.2
MCNZ. (2021). Use of the internet and electronic communication. https://ww.mcnz.org.nz/assets/standards/4874967a0f/Statement -on-use-of-the-internet-and-electronic-communication.pdf
2 Health and Disability Commissioner. (1996). Code of Health and Disability Services Consumers’ Rights. https://www.hdc.org.nz/your-rights/about-thecode/code-of-health-and-disability-services-consumers-rights/ 3 Privacy Act 2020 No 31 (as at 12 April 2022). Public Act Part 3: Information privacy principles and codes of practice. https://www.legislation.govt.nz/act/ public/2020/0031/latest/LMS23376.html
WWW.ASMS.ORG.NZ | THE SPECIALIST
Similarly, it is difficult to document the advice you have received, as aliases are often used on these forums. In the event of a complaint, it would be difficult to justify management based on the advice provided by ‘X’ person on a social media forum. From the perspective of someone providing advice on social media, you may like to consider that you have less information than a so-called ‘corridor consultation’. It is also difficult to ask for more detail on social media. Some unintended consequences of giving specific management advice could be that the advice is interpreted incorrectly or that there is a poor outcome for the patient. Additionally, if this advice is given with your personal profile, your reputation may also be adversely affected. Workplace policies So how do employers view posts on social media? Many workplaces and employers will have a policy around posting on social media. For example, some employers will not allow posting of patient information on social media. Additionally, if critical comments are made about an individual’s
employer, the employer may then have access to this, and issues may arise around professionalism and adherence to organisational policy. Medical forums on social media have taken a number of practical approaches to facilitate discussion of interesting medical cases whilst maintaining patient privacy and professionalism. Some platforms allow settings that permanently delete messages within a day of posting and allow documents to be viewed only once without sharing. We all benefit from discussion and learning from unusual presentations and challenging cases. From a practical perspective, these large forums are very useful for commenting on appropriate referral processes or protocols used in a given region. However, for the reasons outlined, using social media forums to seek advice about the management of individual patients can be quite problematic and create professional risk. The safest approach is to consider any social media post to be both permanent and accessible to any member of the public.
DID YOU KNOW? When your employment moves from DHBs to Health NZ on 1 July there will be no change to your terms and conditions of employment. The legislation establishing Health NZ states that on 1 July every DHB employee becomes an employee of Health NZ “on the same terms and conditions as applied immediately before they became an employee of Health New Zealand.” That means the protection and transfer of: •
All provisions of the current MECA (either the 2020-21 MECA which is still in force, or any MECA resulting from the current negotiations) Any DHB-specific or departmental/service agreements that have been negotiated in addition to the MECA
• Any individual conditions, such as your MECA salary step and anniversary date.
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As an existing employee, you cannot be required to work outside of your former DHB district if that was a condition of your original employment, unless you make a new agreement with Health NZ. There can be no change to your salary, any local employment agreements which are in place, or additional arrangements you may have. Any proposed changes affecting any aspect of your work or the work of your service must be mutually agreed, which is what happens now under the MECA. If you have any concerns, please contact your industrial officer.
Beyond the Mask
Are you a sculptor, fine artist, ceramicist, potter, photographer, or textile artist?
Executive Director Sarah Dalton
For the second year running, the Association of Salaried Medical Specialists Toi Mata Hauora is hosting an art exhibition featuring the artworks of doctors and dentists. It is open to specialists, GPs, dentists, residents, and house officers, including medical and dental students.
The exhibition will be professionally curated by the New Zealand Academy of Fine Arts in Wellington where the works will be displayed.
Senior Communications Advisor Elizabeth Brown Senior Communications Advisor Andrew Chick Industrial
It will open on 23 November with a gala event to coincide with the ASMS Annual Conference and will run for nine days.
Senior Industrial Officer Steve Hurring
The artworks will be up for sale and there will be prizes for categories such as ‘best in show’, ‘best new artist’, ‘curator’s choice’, and ‘people’s choice’. Last year’s prizes totalled $10,000.
Senior Industrial Officer Lloyd Woods
If you would like to submit something, please contact our industrial officer Lloyd Woods at firstname.lastname@example.org
Senior Industrial Officer Henry Stubbs Industrial Officer Ian Weir-Smith Industrial Officer David Kettley
ASMS services to members As a professional association, we promote: • the right of equal access for all New Zealanders to high quality health services • professional interests of salaried doctors and dentists • policies sought in legislation and government by salaried doctors and dentists. As a union of professionals, we: • provide advice to salaried doctors and dentists who receive a job offer from a New Zealand employer • negotiate effective and enforceable collective employment agreements with employers. This includes the collective agreement (MECA) covering employment of senior medical and dental staff in DHBs, which ensures minimum terms and conditions for more than 5,000 doctors and dentists, nearly 90% of this workforce • advise and represent members when necessary • support workplace empowerment and clinical leadership.
ASMS job vacancies online Check out jobs.asms.org.nz a comprehensive source of job vacancies for senior medical and dental specialists/consultants within New Zealand hospitals and health services. Contact us Association of Salaried Medical Specialists Level 9, The Bayleys Building, 36 Brandon St, Wellington Postal address: PO Box 10763, The Terrace, Wellington 6143 P 04 499 1271 E email@example.com W www.asms.org.nz Follow us facebook.com/asms.nz twitter.com/ASMSNZ Have you changed address or phone number recently? Please email any changes to your contact details to: firstname.lastname@example.org If you have reason or need to seek a reduction or waiver to your annual subscription, please write to us. Our constitution allows for this in certain circumstances. Emails should be addressed to email@example.com
Industrial Officer George Collins Industrial Officer Kris Smith Industrial Officer Georgia Choveaux Industrial Officer Jenny Chapman Industrial Officer Tanja Bristow Policy & Research Director of Policy and Research Charlotte Chambers Policy Advisor Mary Harvey Health Policy Analyst Lyndon Keene Policy and Campaigns Researcher Harriet Wild Support services Manager Support Services Sharlene Lawrence Membership Officer Saasha Everiss Support Services Administrator Cassey van Riel Finance and Technical Support Advisor Vanessa Wratt
PO Box 10763, The Terrace Wellington 6143, New Zealand +64 4 499 1271 firstname.lastname@example.org
WWW.ASMS.ORG.NZ | THE SPECIALIST
Join the KiwiSaver provider driven by purpose, not by profit. The KiwiSaver provider that’s inspiring healthier communities and a healthier planet. Join today. mas.co.nz/kiwisaver
Medical Funds Management Limited is the issuer of the MAS KiwiSaver Scheme. The PDS is available at mas.co.nz.