The Specialist - September 2022 | Issue 132

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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

Invasion of the bodyscanners Do scary stories repel radiologists from coming here?

132 | SEPTEMBER 2022


Inside this issue ISSUE 132 | SEPTEMBER 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: Andrew Chick Designer: Twofold If you have any feedback on the magazine or contribution ideas, please get in touch at asms@asms.org.nz.

Prefer to read The Specialist online? We have listened to your feedback and are aware that some members prefer not to receive hard copies of the magazine. If you want to opt out of the hard copy, just email membership@asms.nz and we can let you know via email when the next issue is available to read online. The Specialist is produced with the generous support of MAS.

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THE SPECIALIST | SEPTEMBER 2022

03

As a matter of fact

04

A season for new opportunities

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Border policy slows the brain gain

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Charity ambulance services causing staff woes

10

Commercial determinants in the spotlight

12

Te Tiriti together

14

Accidental pirates

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We’re going to need a bigger boat

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Problems really starting to bite

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Five minutes with Dr Tanya Wilton

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Health concerns for holders of a firearms licence

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In brief

24

Did you know?

25

Haere ra Dr Charlie Chambers

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ASMS Annual Conference 2022

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ASMS welcomes some new staff…


As a matter of fact Dr Julian Vyas | ASMS President

In my previous column I cited Aldous Huxley’s quote that “facts don’t cease to exist just because they are ignored”. In this column I want to ask what happens when we don’t have any facts? For the last 33 years ASMS has been asking government and health leaders to properly staff the health system. To answer that sort of question, you might expect health leaders would have developed robust methods to measure and report on actual staffing.

not the capacity to provide their multidisciplinary and long-term outpatient needs as well. The longer-term aim might be to provide such chronic care within community settings. But the current capacity of primary care is also inadequate.

Following from that and, again, given how long we’ve been asking, you’d expect our employers to have developed service planning on a proactive basis, not just as a means to catch up with the existing unmet need.

So, to avoid all this and provide for these needs properly, accurate data is vital. Without it, the necessary steady improvement in public health care provision in New Zealand will remain hostage to fortune.

Sadly, you would be wrong on both counts. It would appear none of the above was business as usual under DHBs. Now Te Whatu Ora must make it an immediate priority. Right now, government does not know exactly how much work dentists and doctors are having to do to keep New Zealand health care afloat. Without that information they can’t plan the recruitment to meet the increased caseloads that will follow tackling ‘unmet need’. Equally, strategies to address the backlog in planned care have no analysis of what this means for health care capacity. There is a public focus on surgery in addressing planned care. But we know that health care is more than just the number of operations done. Over half of health care provided is for chronic conditions, as opposed to acute care or surgery. Addressing the backlog in planned care may result in a greater need for chronic care capacity too; and not just as a one off, as with surgery. Equally, simply reducing the number of patients waiting for a first specialist appointment is futile if there is

To continue a haphazard approach to workforce planning risks us all facing years more overwork. And overwork will further damage morale, which in turn erodes willingness to contribute to system development.

“To continue a haphazard approach to workforce planning risks us all facing years more overwork. And overwork will further damage morale.” While Te Whatu Ora faces many immediate demands, now really is the time for this one. For many years, including in our 2020 report Building the Workforce Pipeline, Stopping the Drain, we’ve been calling for the coordination and publishing of a regular medical workforce census. Until now, the fractured DHB management structure has been one key factor that has seen that idea assigned to the too hard basket. Now we have a single employer. It’s time for Te Whatu Ora to get cracking.

IMPORTANT: Constitutional remits at Conference 2022 This year we have two remits proposing constitutional change that will be voted on at our Annual Conference. You can find more information about registration for Conference on page 26 of this magazine and at asms.org.nz. We really hope as many of you as possible can attend. But for those of you who cannot, we encourage you to talk with your colleagues who hold voting rights at conference. By the time you read this

you will have received an email with details of the remits, as well as access to some useful FAQs. You might also find that the article on page 12 – Te Tiriti together - offers some helpful context for thinking about the remits. And if you have further ideas, questions, or comments you’d like to put, please drop us a line: sd@asms.nz

WWW.ASMS.ORG.NZ | THE SPECIALIST

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A season for new opportunities Sarah Dalton | Executive Director

It’s August. It’s cold, it’s wet and there’s nothing good to see in the news. Instead, I’m fielding media queries about the 25% increase in complaints to the Health and Disability Commissioner. However, you’ll be reading this in September. The Wellington northerly should be back, the skies will be lighter, temperatures rising and – my profound hope – the worst of the winter surge will be behind us. Which is why I’m disposed to writing a column that is more optimistic than my current mood. So, first item of good news… Having a single employer instead of 20 across our network of hospitals is already showing potential to achieve better, and quicker, system-wide outcomes for you. We have already picked up significant pieces of unfinished business from the MECA negotiations as priority items. One is addressing the gender pay gap; another is achieving fair terms and conditions for shift workers. The mix of interim and permanently employed Te Whatu Ora – Health New Zealand (HNZ) staff who have responsibility for this work (former chief executives, HR leads, and employment relations managers from the business formerly known as TAS) are better equipped and supported to tackle these issues. We have a very long list of ‘to-do’ items, and have already started regular meetings to progress them. We have also had some positive responses to concerns we have raised about the uneven application and response to the winter surge payments – an early lesson that what’s agreed at the centre doesn’t necessarily trickle down promptly to the districts. Also, that delegation across HNZ need some work. HNZ has agreed to talk some more about the previous employers’ unilateral decision to remove the automatic five-year CME accumulation arrangement, which was applied back in 2020, when our borders closed. It is tempting to suggest that the abrupt removal of the five-year CME accumulation was a last gasp of a dying system, and that the fresh fields on which HNZ is being built offer reason for hope – and that our proposal, that the return to the MECA standard arrangements should be gradual and well-signposted rather than abrupt and unheralded, should stand. Time will tell – and it will be a decent test for your new employer. Meanwhile, remember that the MECA still entitles every member who wishes to accumulate CME funds for longer than three years to request this. Clause 36 outlines the process, and your local industrial officer can help if you need it.

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At the dentists’ conference in July, we quietly launched our latest publication, Tooth be told: The case for universal dental care in Aotearoa New Zealand. You can find it on our website, and we’ll happily send you a hard copy if you’d like one. I suggest you make an appointment with your local MP and take it as a gift. Everyone loves a present!

“Having a single employer instead of 20 across our network of hospitals is already showing potential to achieve better, and quicker, system-wide outcomes for you.” With the 2023 general election looming, now is a good time to think about how you’d like our health system to be funded, and how you’d like health workforce investment to be improved and supported over the coming years. All the political parties should have something to say about these things, but none of them have the depth of knowledge and experience that you – as senior doctors and dentists – can bring. Rest assured, we continue to educate and advocate for a system where best evidence and clinically led decisions drive provision and development of services, but you too can (and should) have your say. Think about what matters most to you – and how best you can shape the larger political discussions about the kind of health system we need, as opposed to the one we have. Both health funding and workforce pressures will loom large as discussion topics at our Annual Conference, to be held in Wellington on 24–25 November. We are hosting a second art exhibition at the Academy of Fine Arts (launch party on 23 November), and we’re exploring the possibility of hosting a screening of Dr Paul Trotman’s documentary film Behind the Mask. Our conferences are always full of camaraderie, information-sharing, politics and good times. It would be great to see you there. There will also be constitutional remits on the table this year, and an opportunity to hear from and speak to the Minister of Health. Places will be limited, so make sure to register soon if you haven’t already (you can find out more on the ASMS website at www.asms.org.nz/event/asms-annual-conference).


Border policy slows the brain gain Matt Shand | Journalist

The Government plans to make immigrating to New Zealand easier for health care professionals, but does our immigration and registration process mean we lose good doctors in the bureaucracy? The Specialist speaks to radiologists about what changes could help. All patients needing radiology in Hawke’s Bay are reliant on overseas-trained doctors who have had to brave a lengthy battle to be in the country and authorised to provide that treatment. There is not a single New Zealand trained radiologist working in the region.

for patient needs. But there can be problems getting those IMGs to New Zealand.

Reflecting that pattern around the country, the Medical Council of New Zealand (MCNZ) says it issued 996 registrations to immigrating doctors last year, with just 550 registrations to New Zealand graduates.

“We are advertising, but I hardly get any applicants at all. The few applicants we get are often from countries which are not considered to be comparable health systems, and therefore eligibility for vocational registration with MCNZ is unlikely.

In August, Minister of Health Andrew Little announced a plan to address a shortfall in radiologists by funding 15 more training spots. Hawke’s Bay radiologist Dr Kai Haidekker says training more doctors in New Zealand is important, but it will take 13 years for a first year medical student to become a consultant. This means New Zealand is reliant on attracting, and keeping, international medical graduates (IMGs) to cater

“New Zealand needs to change the way it supports immigrating doctors because we are missing out on filling vacancies,” says Haidekker.

“There are other specialities, like psychiatry, which have a similar problem. We have doctors already working in New Zealand sitting in limbo, waiting 18 to 24 months to get residency. They cannot even buy a house and settle. It’s just not good enough.” Little announced changes to the way immigration will be conducted at the start of August, including: WWW.ASMS.ORG.NZ | THE SPECIALIST

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"However, sometimes the MCNZ process feels disproportionately oncerous when the IMG is from a Western European country with implicit high training standards" Dr Richard Cooper

covering international doctors’ salaries during their six-week clinical induction course and three-month training internship

dedicated immigration support services to make it easier for health workers to move to New Zealand.

for residency in November 2020 but everything shut down. For 18 months we sat there with nothing. “There are a lot of things you cannot get access to in New Zealand if you do not have residency. “Simple things you take for granted like getting credit cards or bank loans. You cannot buy a house, and that has affected me a lot.”

Stalled immigration processing Radiologists from Haidekker’s department will likely form part of that training process but only because their international doctors have persevered through the minefield of the immigration process themselves.

This limbo doctors get stuck in can have flow-on effects for staffing numbers, says Kahn-Ziech. “New Zealand is reliant on foreign doctors, and we need more. We’re understaffed and need more people to come here to work. If foreign doctors are not looked after, they don’t have their families here, they can’t even buy houses here, they will just leave.”

Radiologist Dr Richard Cooper had been living in New Zealand one year, to the day, when contacted by The Specialist. “Of the four-stage process I am still at stage two,” he said. “Immigration NZ has no idea when I will progress to stage three. I have a work to residency visa but, like a lot of doctors, I am stuck in the process.”

While navigating the immigration process, most are also handling MCNZ registration simultaneously, as well as adjusting to a new country.

Delays in residency cause several issues for people wanting to call New Zealand home. The main issue is the inability to buy property. “This makes it difficult for me to feel settled,” he said. “I have an offer on a house, but its purchase is conditional on getting residency. I know of other doctors who have given up and left. They can’t live like this or expect their children to live like this, so they leave. As a whole, New Zealand misses out.” Cooper says the frustration of ongoing delays is compounded by poor communication about the residency process. He decided to write to Minister of Immigration Michael Wood but to no avail. Immigration NZ has recently changed its process so arriving health professionals, including doctors, are fast tracked. However, those arriving before these changes, like Cooper, are sitting waiting and hoping their application will eventually be processed. “Other people who have just arrived are receiving their residency visas within a few weeks. I am very happy for them, but it makes me wonder where mine is. It puts my life on hold. New Zealand needs people like us to run training programmes and deliver vital services to our patients.”

Chief Executive of MCNZ Joan Simeon says the time to gain registration for the majority of IMGs in New Zealand is 20 working days, with 95% of all applications for provisional, general and special purpose registration processed within that time frame. “The Medical Council has some of the most flexible and permissive pathways for IMGs to gain registration in the Western world.” “Our primary role is to protect the health and safety of the public, by ensuring that doctors are competent and safe to practise. “There are a number of pathways to registration for IMGs which take into account the qualifications, training and experience of applicants. They allow the vast majority of IMGs to gain registration without the need to sit and pass an examination. This allows flexibility while ensuring the protection of the public.” Recognition for registration There are 23 countries MCNZ recognises as being comparable to New Zealand, allowing doctors who practised in those areas to apply for registration. “We are continually reviewing the countries recognised,” says Simeon.

Dr Alexandra Kahn-Ziech also found it hard to settle in New Zealand. “When we first thought about moving, Covid didn’t exist,” she says. “We were here June 2020 and wanted to apply

“The process is longer for those coming from countries that are not considered comparable and who wish to gain vocational registration to work at a consultant level in New Zealand.

“We were here June 2020 and wanted to apply for residency in November 2020 but everything shut down. For 18 months we sat there with nothing.” Dr Alexandra Kahn-Ziech

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“The time frame for provisional vocational registration IMG applications is six months, as this is a comprehensive process which involves the relevant medical college in New Zealand providing advice to Council.” If a doctor does not fit into the standard pathways, they need to sit a New Zealand Registration Examination (NZREX) pitched at the level of a final-year student at a New Zealand medical school. Only a few are required to do this, which does add weight to the notion some employers are preferring to go without rather than go through the process. Of the 996 registrations last year, only 3.8% had to sit NZREX to get registration. But one radiologist from a Western European country says the issues with immigration and registration still made them feel like leaving New Zealand. The radiologist says they were part of a Facebook group for German doctors wanting to move to New Zealand. “This is how I found my job,” they said. “But I don’t think there will be any more overseas doctors from this group as it is too much to get them into the country.” Richard Cooper says it is important that the country has a robust registration process and that MCNZ maintains high standards for good reason.

“New Zealand needs to change the way it supports immigrating doctors because we are missing out on filling vacancies.” Dr Kai Haidekker

“However, sometimes the MCNZ process feels disproportionately onerous when the IMG is from a Western European country with implicit high training standards,” he said. “Those going through the registration process while their immigration status remains uncertain may be less inclined to start altogether. “I think New Zealand needs to do more to support those immigrating, which means providing them with a certain, secure future. “Fast track to permanent residency, citizenship and support through the MCNZ process will go a long way. People do not like uncertainty and will take steps to reduce uncertainty for themselves and their families. “We don’t want to lose good doctors this way.” WWW.ASMS.ORG.NZ | THE SPECIALIST

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Charity ambulance services causing staff woes Andrew Chick | Senior Communications Advisor

Widespread burnout and pay rates below the Living Wage are behind calls for charity ambulances to become government operated as staff begin to suffer. One paramedic labels the charitable model a “sinking ship” and says changes are needed to secure the services long into the future. When the emergency telephone number 111 was first introduced, calls were diverted to volunteers, sometimes at their places of work. From 1985 to 1988 in Whangamatā this resulted in emergency calls being diverted to a fish ‘n’ chips shop, often causing some confusion whether the caller wanted an ambulance or some cheap takeaways. The increasing demand for ambulance services has changed the way phone calls were handled. Today, paid triple-one operators handle calls for ambulances, and they are kept busy, with more than 454,000 emergency callouts in 2021 alone. That’s more than 50 calls an hour, every hour of the day. While the way calls to ambulance operators are made has evolved over the years, what remains unchanged is how our ambulance service relies on charity to keep operating and saving lives. Charity only goes so far, with St John reporting its Emergency and Other Transportation Services running at a deficit of $14.5 million.

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“It’s a sinking ship,” South Island paramedic says Ryan (not his real name). “Staff are leaving. It’s blatant people have died from how bad it’s got.” The National Ambulance Service Office – now part of Te Whatu Ora – has terms and agreements with St John and Wellington Free Ambulance to provide ambulance services. But this revenue is not enough to cover the costs of delivering the services, even with St John attracting the goodwill of clinical volunteers worth an estimated $138 million in labour to its service. Details of NASO's arrangements are not publicly disclosed. NASO’s website only says that “a range of operational requirements [are] agreed by the funder and provider” and that “performance against KPIs is subject to ongoing monitoring and reporting”. Ryan says the focus on KPIs is causing undue pressure and “misses the point” of patient care over speed of first responders.


“The Government’s most discernible KPI is how quickly we locate jobs. How quickly the address is verified, how quickly the ambulance is dispatched and then how quickly it arrives. But that measure is not necessarily an ambulance, but a unit. If I’m on my own in a jeep I might get to a job within 25 minutes, but I will have to wait around for 90 minutes for an actual ambulance unit to arrive that can take the patient to hospital. “It looks good [on paper] as a KPI.”

“While double-crewing ambulances with paramedics is quite expensive, would we be happy if only 70% of A&E clinics are going to have doctors?” That year, the Government announced the $15 million a year in extra funding to ensure full ‘double-crewing’, and over the next four years St John added 388 new roles, but they were not all for paramedics. Of the 388 roles St John added, 8 were intensive care paramedics, 28 were paramedics, 28 were emergency medicine technicians and 302 were emergency medicine assistants. The Emergency Medical Assistant (EMA) qualification is a five-day course. Staffing issues have taken their toll on those doing the work. This ongoing theme of health care employees overworking to protect patients continues its trend, and the charity-led model is creating significant disputes about pay.

"It’s a sinking ship. Staff are leaving. It’s blatant people have died from how bad it’s got.” Ryan, Paramedic

Wait times for services and transfers gum up the KPIs, compounded by crowding in hospitals. In June 2022 month-on-month record call outs saw media reports of people waiting 12 hours for an ambulance, and St John reported it spent 3,000 hours for the month before – the equivalent of 125 days – waiting to transfer patients into overcrowded hospitals.

In late 2020, FIRST Union members planned strike action when St John backed out of an agreement to pay time and a quarter on weekend and night shifts due to lack of funds despite a $29 million boost from government. St John’s 2020–21 Annual Report states, “While St John’s ability to absorb some growth through innovation in service delivery will allow us to be sustainable in the short-term, this does not represent an acceptable medium- or long-term financial strategy. In particular, it is becoming increasingly challenging for community support to continue to grow in line with the future service requirements of St John.”

The contracted-out model of ambulance care not only puts strain on paramedics like Ryan, it also still requires significant government top-ups. St John op shops sell an impressive $60 million worth of goods every year, but in 2019 the Government provided a $21 million injection over two years to the ambulance sector to “relieve immediate pressures and provide certainty”. The 2022 budget provided $166 million over four years for 48 ambulances and 13 cars to be added to the road ambulance fleet and up to 248 additional full-time staff to be recruited. “There’s no point having new ambulances if they’re just sitting in stock,” Ryan said.

“It is becoming increasingly challenging for community support to continue to grow in line with the future service requirements of St John.” St John’s Ambulance Annual Report, 2020

“We [at his workplace] don’t have the staffing to crew more than one at a time.” As late as 2017, New Zealand was an outlier in first-world ambulance services in allowing single-crewed ambulance responses. That year, 35,000 ambulance responses were attended by just the driver of the vehicle. “I used to have the display of the monitors on the floor of the ambulance cab while I was driving with the cables dragging back into the back where the patient was. I could look down at the ground and keep an eye on what their heart rate and ECG were doing,” Ryan said.

Ambulances have come a long way in New Zealand since St John set up its first ambulance brigade in Dunedin in 1892. Many owe their lives to the service provided by paramedics under difficult circumstances. As time has gone by, the need and demand of these services has changed along with the funding priorities. As the service has evolved away from having people call a fish ‘n’ chips shop in a life-or-death emergency, perhaps it is now time to evolve the funding model for vital ambulance services.

WWW.ASMS.ORG.NZ | THE SPECIALIST

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Dr Sandro Demaio

Commercial determinants in the spotlight Matt Shand | Journalist

The Annual Conference of Health Coalition Aotearoa tackled the impacts on alcohol, tobacco and junk food on our collective health. Addressing the commercial determinants of health will do more for health equity in New Zealand than even the very best health care reforms, says National Director of the National Public Health Service Nick Chamberlain. His words came at the ASMS-sponsored Health Coalition Aotearoa annual conference at Parliament in August, as part of a panel discussion alongside Director General of Health Dr Di Sarfati and Deputy Director of the Public Health Agency Dr Andrew Old. Chamberlain says industrial food producers have had an inappropriate relationship with New Zealand, and seeing the effects of commercial determinants of health first hand in his hometown led him to apply for the position of National Director. “As you enter Whangārei from the Auckland side you have our second poorest suburb,” he says. “At the entrance of this suburb a McDonald’s was built and then a KFC opened on the other side of the street. There is a hospital up the road and a multitude of liquor stores. Don’t get me started on the vape stores.”

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Chamberlain says he quoted Hugh Grant from the movie Love Actually during his interview for the National Director role – the scene where Hugh Grant as the British Prime Minister stands up to the American President who had taken what he wanted without compromise and bullied his staff.

“The data to inform our work is dated; most would say outdated.” Hon Andrew Little, Minister of Health

Chamberlain says New Zealand has a bad relationship with some large-scale producers of harmful products and the companies act as “bullies”. “A friend who bullies us is no longer a friend and, since bullies only respond to strength, from now onward we must be prepared to be much stronger.” Taking a stronger stance on commercial determinants of health could have large health impacts on the wider population and, in particular, Māori communities.


“There is a two to four times benefit in Māori and Pasifika communities,” says Chamberlain. He urges people to give Health NZ a chance. “As one entity we can implement policy across New Zealand and get greater support from sectors. There are many opportunities in the new [health] system.” At the conference, Minister of Health Andrew Little said Government is committed to tackling alcohol, nutrition and tobacco harm as the three major commercial determinants of health, but there are gaps in their data in some areas. “We’re committed to improving lives and tackling issues,” he said, “[but] the data to inform our work is dated; most would say outdated. Our most recent adult nutrition survey was taken in 2008/2009 and, for children, the so-called current data goes back to 1992. As such, the Ministry of Health commenced work to scope a nutrition survey.” Keynote speaker Dr Sandro Demaio from VicHealth in Australia, talked about the global impact of noncommunicable diseases (NCDs) in Australia. “It is a pandemic on a pandemic,” he said. “Over the last half-century, we have seen these diseases move from what used to be a rounding error in statistics to dominating the world. “In Australia, 89% of all deaths are due to NCDs and 71% globally.” Demaio says reducing commercial determinants is not about tearing down the economic system but about realising where the realities of our modern economic system come at a cost to the health of others. “The reality is the majority of the planet is fed by smallholder farmers,” he said. “It’s easy to forget that.

Nick Chamberlain

There are, though, some groups that carry a significant cost to the public health for the privilege and benefit of just a few.” Demaio says strong political will, public awareness and accountability are key to removing the harms caused by products. Other countries are starting to act with bans or restrictions of advertisements for sugary products – like recommendations made in ASMS’ Tooth be told report – as well as restrictions on alcohol and tobacco marketing.

“It’s a pandemic on a pandemic.” Dr Sandro Demaio, VicHealth

Health Coalition Aotearoa chair Boyd Swinburn says the conference provided an opportunity for those within the public health space to hear from policymakers and hold them to account where possible. He said this is particularly important when some bills set to make a difference to New Zealander’s health may be wavering in the Parliament chambers. “We congratulate them when they are doing well but must be mindful of how bills can change,” Swinburn said. “Two areas we are concerned about are any wavering in the review of the Sale and Supply of Alcohol Act and the proposed regulations protecting children from junk food marketing where they seem to be taking a weaker option.” Swinburn thanked ASMS for their sponsorship of the event and assisting, as senior doctors and dentists are at the coal face of treating the effects of NCDs caused by commercial imperatives.

Di Sarfati

WWW.ASMS.ORG.NZ | THE SPECIALIST

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Te Whare Rūnanga - the House of Assembly, whare whakairo (carved meeting house) at the Upper Treaty Grounds at Waitangi.

Te Tiriti together Harriet Wild | Director of Policy and Research

As recognition of Te Tiriti o Waitangi becomes a norm across the health sector, the work has started at ASMS to fully bring Te Tiriti into the work we do. In the millions of PDF documents that are uploaded to the internet every day, it feels rare to stumble across a report that is both recent and relevant, without the controlled variables of a journal database search or via a press release. A chance encounter on Google has connected ASMS with answers to a question our newly established Rōpū Māori asked at its inaugural hui: How do health professional organisations demonstrate a commitment to Te Tiriti o Waitangi? ASMS stumbled across a recent working paper prepared by Gabrielle Baker, a health policy consultant, for the Law Society’s independent Review Panel on the Regulation of Lawyers and Legal Services in Aotearoa New Zealand. In the working paper, medicine is used as a comparable regulated profession to law, and examples are given of the extent to which Te Tiriti o Waitangi and its principles are integrated into constitutions, strategy, policy, governance and operations. Te Tiriti o Waitangi is increasingly present and visible as a cornerstone of what organisations are doing and how they are doing it. It is now embraced by people, communities and organisations across society and extends beyond the Māori–Crown relationship to something held by many to be uniquely of Aotearoa New Zealand. The health sector is no different. The influence of the Medical Council of New Zealand’s work on cultural safety and hauora Māori, the release of the Waitangi Tribunal’s Hauora report in 2019, and medical colleges adopting strategies and frameworks to improve health outcomes

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for Māori have increased the prominence of Te Tiriti o Waitangi, and how the medical profession can lead and contribute to positive change.

“Te Tiriti o Waitangi is increasingly present and visible as a cornerstone of what organisations are doing and how they are doing it. It is now embraced by people, communities and organisations across society.” The direction of travel is reflected in the Pae Ora (Healthy Futures) Act 2022, the legislative architecture of the health system reforms. Tangible expressions of Te Tiriti o Waitangi include the establishment of Te Aka Whai Ora (the Māori Health Authority) and Section 6 of the Act, which details how the health sector can give effect to Te Tiriti, from policy design through to implementation. The Pae Ora Act is deliberately inclusive, shifting from using the word ‘system’ (which could be interpreted as operational aspects of health) to ‘sector’, thus extending beyond the design and delivery of health care. This framing provides the diverse range of organisations and groups involved in health in Aotearoa New Zealand an opportunity to align their work with elements of the Act. So how did medical professional organisations stack up in Gabrielle Baker’s research? Measures included:


minimum Māori membership requirements on boards and executive bodies

50-50 Māori/non-Māori governance arrangements

explicit Te Tiriti o Waitangi commitment/statement in constitution, rules or policy

specific projects focused on Māori.

The report covered the Medical Council of New Zealand (MCNZ), the Council of Medical Colleges (CMC), the Royal New Zealand College of General Practitioners (RNZCGP),

demonstrate Te Tiriti and its principles, embrace kaupapa Māori values, and appoint tangata whenua to boards because they see it as integral to our context in Aotearoa New Zealand. In 2021, there were more than 60 Māori medical school graduates from the University of Otago. Te ORA, the Māori Medical Practitioners Association, urges vocational colleges and health professional associations to get ready for greater numbers of Māori doctors coming through, noting that there will be expectations for institutions to

Comparison of approaches to Te Tiriti o Waitangi by a sample of medical professional groups Governance and Policy 50-50 Māori/ Māori or Minimum non-Māori Te Tiriti Māori governance membership competency requirements requirements arrangements

MCNZ

Co-Chair (Māori/ non-Māori)

Operations

Māori (sub) committee

X

CMC RNZCGP

X

ACEM

Māori on Explicit Executive, or Te Tiriti commitment staff advisors commitment statement in policy/ strategy/rules

Specific projects focused on Māori

X

X

X

X

X

X

X

X

X

X

NZMA ASMS

Formal partnership agreements

Under consideration

X Under development

Under development

Source: Baker G. Te Tiriti o Waitangi and professional organisations in Aotearoa. A Working Paper prepared for the Independent Review of the Regulation of Lawyers and Legal Services in Aotearoa New Zealand. June 2022. https://legalframeworkreview.org.nz/wp-content/uploads/2022/08/WP3-professional-organisations-and-Te-Tiriti.pdf

the Australasian College for Emergency Medicine (ACEM), the New Zealand Medical Association (NZMA) and ASMS, and collectively, all organisations had room for improvement. All had at least one of the measures identified – except for ASMS. For ASMS specifically, the report notes, “While ASMS does not appear to have any of the factors in place currently, its 2021 Annual Report states it is actively pursuing an ‘equity kaupapa’ and is looking to establish a Māori advisory committee.” Since this report was written, there have been changes to acknowledge the incorporation of Te Tiriti o Waitangi in the ASMS–DHB MECA, and the first hui of Rōpū Māori, held on 1 July 2022 – an auspicious day, given its coincidence with the establishment of Te Aka Whai Ora. These are important first steps, encompassing a commitment to promoting Te Tiriti principles and their implementation in the workplace, and recognising the inalienable rights of Māori guaranteed by Te Tiriti – including the right to health. Incorporation of Te Tiriti o Waitangi and Māori representation in governance is now normal for most health care workers. Medical students, registrars and senior doctors are demanding that their professional bodies

be culturally safe, to be anti-racist, and to demonstrate commitments to Te Tiriti o Waitangi and hauora Māori. It is fundamental for health professionals to acknowledge their own roles in supporting Māori aspirations and Te Tiriti in practice. Associate Professor Heather Came and colleagues from the Auckland University of Technology note: “Health professionals occupy intimate spaces in Māori lives, as they do with all citizens, whether they are promoting good health, protecting communities or caring for the sick. It is vital that the work of health professionals is aligned with the full health aspirations of Māori as outlined in Te Tiriti.” While there is no singular path to progressing Te Tiriti responsiveness, there are principles to which organisations can look to inform their journeys. These can be derived from the updated Te Tiriti principles recommended by the Waitangi Tribunal, and further embedded in He Whakamaua: the Māori Health Action Plan 2020–25 (tino rangatiratanga, partnership, active protection, equity and options), as well as ethical principles drawn from Te ao Māori (the Māori world) itself, including whanaungatanga (relationships), manaakitanga (support), mōhiotanga (insight) and rangatiratanga (self-determination).

E tū, whānau! Join our ASMS Rōpū Māori ASMS is establishing a Māori collective, as part of our ongoing Te Tiriti and equity kaupapa. Our Rōpū is keen to connect members who whakapapa Māori. Email hw@asms.nz for more information and to join the ASMS kūmara vine. Mauri ora!

WWW.ASMS.ORG.NZ | THE SPECIALIST

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Accidental pirates Andrew Chick | Senior Communications Advisor

Not to be confused with Talk Like a Pirate Day, PIRATE Day (Pre-hospital Initial Response And Treatment Education Day) is an opportunity for medical specialists to apply their skills in an emergency outside the hospital or clinical environment. “PIRATE Day is a course designed to make in-hospital doctors more useful if they are the first on the scene of a medical emergency or trauma,” says Kerry Holmes, an anaesthetist at Waitematā Hospital and a doctor with the Auckland Helicopter Emergency Medical Service since 2019. “A doctor at the scene should be able to do a lot in an emergency,” says Holmes, “but it takes special training and equipment to maximise usefulness.” “Our aim is to teach lots of doctors from all different specialties so that there are loads of doctors in the community that can be giving high level care in the first 15 minutes after an accident takes place.” On a squally Saturday last July, 14 specialists gathered at Ardmore Aerodrome in South Auckland, home of the Auckland Helicopter Rescue Trust. The group, which included geriatricians, orthopaedic surgeons, gynaecologists, and infectious disease specialists, started with some hands-on instruction before a series of very realistic simulations to put new skills into practice. From a car-crash to a drowning to a serious fall, participants had their practical and social skills tested. With paramedic students cast as patients and onlookers,

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some excellent sound effects and some judicious use of make-up, cuts of meat and a garden sprayer, the scenarios were enough to convince more than a few members of the public who wandered by it was a ‘real’ emergency. In between, there was an opportunity to take a ride in the Westpac rescue helicopter. As well as training and an opportunity to apply their skills, each participant was provided a well-stocked bespoke trauma pack to keep in their car to maximise their ability to help in the future. PIRATE Day also benefits back to emergency medical services, with all proceeds from course fees going into a fund for purchasing educational equipment for ongoing training, and funding paramedics to attend national and international courses. Delayed by Covid-19, 2022 is the second time that PIRATE Day has been run. But Kerry is keen to make sure it keeps going and growing, with even more specialties represented and greater spread across the country. “We can be very siloed in our sub-specialty worlds, so having a course where people from a wide range of specialities can interact together is an added bonus.”


To find out more about PIRATE Day, visit www.pirate-day.org

WWW.ASMS.ORG.NZ | THE SPECIALIST

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We’re going to need a bigger boat Lyndon Keene | Health Policy Analyst

ASMS Health Policy Analyst Lyndon Keene looks at New Zealand’s looming infrastructure challenges and their flow-on effects on health funding. Addressing New Zealand’s infrastructure challenges over the next 30 years could cost more than $1 trillion, a report shows.

New Zealand’s relatively low spending on health is a consequence of having a relatively small government and conservative fiscal policies. While our GDP per capita is around average for OECD countries, our general government spending as a proportion of GDP is among the lowest in the OECD.

New Zealand’s infrastructure challenge report, prepared by Sense Partners, identified “decades of under investment” in the country’s health care, water, power, roads and rail in the 1980s and 1990s.

There is no way our small country can afford the trilliondollar price tag to buy out this infrastructure deficit. Instead, the future of infrastructure development will

That underinvestment has major implications for how the health system will be funded.

FIGURE 1: HEALTH EXPENDITURE AS A PERCENTAGE OF GDP: NEW ZEALAND AND AVERAGE OF 14 COMPARABLE COUNTRIES*, 1980 TO 2020 14.0

Average percentage points

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*Australia, Belgium, Canada, Denmark, Finland, France, Germany, Italy, Netherlands, Norway, Sweden, Switzerland, UK, USA

ASMS has called for an honest appraisal and public debate to determine more appropriate levels of health care spending. The fragility of the system, exposed by the pandemic, shows we need health care investment more than ever. New Zealand’s spending on health care as a proportion of gross domestic product (GDP) has lagged well behind that of 14 comparable countries since the 1980s (Figure 1). An additional $6.7 billion was needed in 2020 for New Zealand to match those countries’ average level of spending. There is no ‘correct’ level of health spending as a proportion of GDP, but it can offer a rough comparison of how much value a country places on health.

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be about “reducing costs and prioritising”, says Finance Minister Grant Robertson. ASMS says the health care sector must be part of this prioritisation for the social good of the country. There are stark lessons here about the consequences of neglecting health and social investment. Health Ministers over recent times acknowledge years of underfunding have led to today’s health care crisis. In Palmerston North we have members saying medical facilities built for 17,000 patients a year are dealing with 50,000. The cost of inaction comes in terms of social cost and patient health. Less infrastructure means longer wait times and stress as well as pressure on doctors, nurses and staff to treat patients more quickly.


We need reductions in costs to be more than just people doing ‘more for less’ – we need to reduce patient numbers either through public health investment and preventative ways to stop people needing health care in the first instance. The Public Finance Act requires governments to formulate fiscal strategy to have “regard to its likely impact on present and future generations”. Such consideration has clearly been absent over many years in the decision-making on investing in infrastructure, health included. As a result, generations of today have to bear the substantial costs. The prospects of health funding getting the quantum leap required to address unmet need depends on today’s Government adopting bolder fiscal policies accounting for the compelling evidence of the health and economic benefits in doing so.

“The cost of inaction comes at social cost and patient health. Less infrastructure means longer wait times and stress as well as pressure on doctors, nurses and staff to treat patients more quickly.” Politicians wax lyrical with talk about how we need to do things differently in the health sector and changing the paradigm. This same argument needs to be said for how governments go about funding the health care system.

Also in the mix... A recent report by barrister Warren Forster proposes an overhaul of the ACC system, with the aim of realising Sir Owen Woodhouse’s original 1967 vision of an ACC scheme as a single system of care and support no matter the cause of a person’s impairment. “We started this world-leading work but have never taken the intended next steps, and now 50 years have passed, and the job is not finished,” says Forster. His proposals include four enforceable rights to social and income support, habilitation and health care, and the development of a sustainable funding model. “We can become world leaders again in the field of care and support for all our people, or we can

choose to perpetuate the fragmented, incomplete, and broken system that history has shown does not work,” says Forster. The reform’s funding would require a move away from relying on taxation or levies. He proposes a sovereign wealth fund, like the superannuation fund, that would help increase “intergenerational equity”. It would need multi-party political consensus on its structures, funding and use, he says. The model would spread the return on investment across the system to fund the gap between taxation or levy collection, and health and social inflation. His report was presented to MPs in Parliament in August.

WWW.ASMS.ORG.NZ | THE SPECIALIST

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Decayed teeth removed in 250,000 adults Every year about a quarter of a million due to decay.

Decayed teeth removed in 1-in-10 children

Highest unmet need for dental care unmet need for adult dental care among 11 comparable countries in 2020.

About one in 10 children have teeth removed due to decay.

Problems really starting to bite Elizabeth Brown | Senior Communications Advisor

ASMS is putting a political stake in the ground over access to oral health care in a new report. Tooth be told – The case for universal dental care in Aotearoa New Zealand brings together official data and evidence about the current state of dental health care. It also includes comments and observations from our frontline dentist members. It doesn’t paint a pretty picture. Hundreds of thousands of New Zealanders have teeth removed each year due to decay, a large percentage of adults never see a dentist, and some communities have little or no access to dental services. The report outlines some hard-hitting facts. •

Every year about a quarter of a million adults have teeth removed due to decay.

About one in ten children have teeth removed due to decay.

Publicly funded hospitalisation rates for oral health increased by 31% in the ten years to 2019.

In 2020 well over 1.5 million or 40% of adults were estimated to have an unmet need for dental care due to cost.

New Zealand recorded the highest unmet need for adult dental care among 11 comparable countries in 2020.

Funding for oral health care amounts to just over 2% of Vote Health operational funding.

New Zealand’s dentist and dental specialist workforce is one of the lowest per capita among OECD member countries.

Our hospital dentists, dental specialists and oral surgeons working in hospitals and in the community are the

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ambulances at the bottom of the cliff, as they deal with increasing medical complexity and unmet need due to what they say comes from complex neglect. They are pulling children’s teeth under anaesthetic, they are dealing with a big uptick in referrals for medically complex patients, and they are turning people away in pain because of long waiting lists and a stark lack of resourcing. Covid-19 has only added to the pressures. Dr Hadleigh Clark is an oral medicine specialist with the Auckland Regional Hospital & Specialist Dentistry service. He says regular dental attendance rates among New Zealanders have dropped significantly over several decades, driven primarily by economic and cost of living factors. “We have a double whammy currently. Due to the successes of medicine, patients are now able to live with multimorbidity and polypharmacy, making them medically more complex. However, at the same time, we are seeing a lower baseline of oral health. If someone has terrible oral hygiene or a mouthful of caries and then they get the oral ulcerative diseases that we’re seeing and treating in the oral medicine clinic, they are already in a more precarious state. “They are not engaging with their dentist to stay on top of baseline oral health, and then they get problems on top of that. There is often an expectation that we will pick up that work (e.g. cleaning and fillings), on top of their specialist care in the hospital. But that is more appropriately addressed in the community with the development of long-term relationships of care.”


40% of adults can’t afford dental care In 2020 well over 1.5 million or 40% of adults were estimated to have an unmet need for Pasifika adults the figure is more than 50%.

31% increase in hospitalisations Publicly funded hospitalisation rates for oral health increased by 31% from 2007/08 to 2018/19, while the population increased by 17%.

Low workforce numbers still falling workforce is one of the lowest per capita in the OECD. The number of practising dentists and dental specialists has dropped.

“We find with our relief of pain service – people will default to whatever gets them out of pain and gets them on with life no matter what the long-term consequences. They’ll go for an extraction rather than trying to save a tooth." Dr Anna Dawson

Inequity and access Community dentist Tihema Nicol is with the regional dental service based in the Hutt Valley. She sees the seeds of unmet need rooted in social inequities. She says when a child has a mouthful of dental caries, all the markers of social deprivation come into play. For vulnerable families, daily dental care can be way down the list of priorities. “The other day I was in a mobile van visiting a school in a high need area. In other areas you might see 18 kids during the day with one or two needing treatment. “In this van I was only able to see 12 children because of the level of decay and the amount of work that needed to be done. Of those 12 kids, all but two needed dental treatment.” There are sizeable communities in New Zealand where there is simply no local dental care available. The northern Hawke’s Bay town of Wairoa lost its last dentist in 2020. It took two years for a publicly funded locum to arrive, and the service on offer is limited. Across large swathes of the South Island, you might have to drive four to five hours just to get a filling. Many public health dentists would like to see a community-based model where community dentists paid for by government would sit in community health hubs, sitting alongside GPs, physios and pharmacies. Somewhere patients could find all their health care in one place. Dr Anna Dawson is with the Auckland Regional Hospital & Specialist Dentistry service. She says there are groups which may not need hospital dental care but could do with specialist hospital dentistry

co-ordination in the community, such as mental health patients or patients with rheumatic heart disease who are at risk of developing endocarditis. “We see a lot of patients who might come in because they have an acute condition and need a heart valve replacement. But before and after that they need regular ongoing dental treatment. “You might see them for that one-off heart valve replacement, but where do you discharge them to? They don’t have their own dentists like a person would have their own GP. There is no funding for them to go to a private dentist.” Burden and workforce pressure Unaffordable dental care translates into a burden on the public health system, and hospital dentists are struggling under the weight of ever-increasing referrals and growing waiting lists. Hadleigh Clark says the situation has got tougher. “We used to manage seeing patients in a timely fashion, but in the past few years, because there is no resilience or flexibility with such low on-the-ground workforce numbers, it means every day we’re not seeing patients or working at 20% clinical capacity (as we had to during lockdowns). It’s just backing up. “Once upon a time we would have seen well over 90% of our oral medicine patients within our KPIs … now there will be patients waiting six or nine months, which is not great.” Taking effective leave is often difficult. “Locum cover is virtually non-existent across the majority of dental specialties. When I come back, I get twice as exhausted because I have to catch up on the inevitable backlog.” WWW.ASMS.ORG.NZ | THE SPECIALIST

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The fix Key recommendations for the future of dental services

1 Extend fully subsidised basic dental care for children to adults. This could be implemented incrementally, beginning with low-income adults.

Urgently develop a dental workforce plan which includes strategies to ensure services are fairly distributed nationally, in partnership with local communities, and based on local needs.

Political football At its annual conference in 2018, the Labour Party voted to adopt a policy of free dental care, but there’s been no mention of it since.

Make options available for dentists to be employed on a salary as part of the public health service, and co-locate community dental services alongside other primary and hospital providers.

Its policy on sugar consumption is to rely on industry self-regulation. It is looking at a proposal to ban sugary drinks in primary schools, but it’s been criticised for not going far enough.

This year’s Budget did fulfil a repeated election promise to boost the emergency WINZ special needs grant for dental care from $300 to $1,000 – but it came after 25 years with no increase at all.

A petition by Health Coalition Aotearoa, presented to Parliament in June, calls for sugary drinks to be banned from all New Zealand schools, along with new rules to force schools to supply only healthy food.

Anna Dawson says patients’ teeth have been treated as expendable due to the years of low emergency funding, and she questions whether it’s the right model at all.

ASMS Executive Director Sarah Dalton says, “Good oral health is fundamental to general health and wellbeing. It’s time that was recognised and we started treating it as a priority in terms of cost, access and funding.”

“We find with our relief of pain service – people will default to whatever gets them out of pain and gets them on with life no matter what the long-term consequences. They’ll go for an extraction rather than trying to save a tooth. “I’d rather that people on lower incomes were being enabled to get preventive care in the form of regular check-ups, cleaning, fluoride and early treatment of decay.” Sugar tax Recently the Government once again ruled out a sugar tax, despite new WHO-funded research showing conclusively that sugar taxes have led to a 15% dent in sales of sugary drinks in other countries.

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The key recommendation in the Tooth be told report is to fully subsidise basic dental care for children and adults. It could be introduced incrementally, starting with low-income adults. It calls for a sugar tax and a dental workforce plan to ensure dental services are distributed fairly across the country, and there are options to employ dentists as part of the public health service. “We can’t continue with prohibitively expensive dental treatment which feeds directly into overall health inequity. This report is confronting and shows that brave political action is what is needed so that everyone can access the benefits of good oral health,” says Sarah.

“They are not engaging with their dentist to stay on top of baseline oral health, and then they get problems on top of that.”

“I was only able to see 12 children because of the level of decay and t he amount of work that needed to be done. Of those 12 kids, all but two needed dental treatment.”

Dr Hadleigh Clark

Dr Tihema Nicol

THE SPECIALIST | SEPTEMBER 2022


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Dr Tanya Wilton Dr Tanya Wilton works as an emergency medicine specialist at Hutt Hospital and is ASMS Hutt Valley Branch President. Her cat Mildred also requires some attention. What inspired you to get into your field of medicine? I really enjoy a variety of medical specialities. I was confident I was going to become a generalist of some sort and I had narrowed things down to general practice or emergency medicine. The teamwork in emergency appealed to me. The fact you are busy, always moving and that it is not a static speciality is what grabbed me. What are some of the challenging aspects of your job? It’s a good and bad thing but the unpredictability can get a little too much at times. It would be great if all our unwell patients could space themselves out a bit, but often it is a feast of critically unwell patients. That, combined with current staffing difficulties, makes it incredibly challenging to respond adequately. What do you find rewarding about your job? The teamwork is the most rewarding thing. I work with an incredible group of people. This ranges from the medical colleagues I interact with to a lot of different medical teams from the community and within the hospital. It is the dynamic nature of things and the bouncing around of ideas that appeals. People dig deep in terms of their caring ethos, and we like to work together to think ahead to where our patient will eventually end up. Hopefully,

we can address issues that prevent the patient having emergencies in the future. What do you see as the biggest challenge facing the health system? I feel like I am a broken record on this one but it’s about having hands to provide excellent care for patients. There must be some way of modelling anticipated needs and managing resources we need in those spaces. What keeps you happy outside of work? I like to stay physically active. I do sea swimming and I enjoy walking and camping. I’m trying to get myself fit enough to walk the Milford and Routeburn tracks. I’m excited to see those. I am also kept busy as a chauffeur / netball coach / sports team manager for my children. I am a presiding member for my child’s school Board of Trustees which I find interesting. Why did you become involved in ASMS? I became involved in ASMS because I was concerned about the conditions under which we were working. I came along to a Joint Consultative Committee and then I just felt at home. I liked the people and there were interesting discussions. I felt like they were my people.

“The teamwork is the most rewarding thing. I work with an incredible group of people.”

WWW.ASMS.ORG.NZ | THE SPECIALIST

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Health concerns for holders of a firearms licence Dr Andrew Stacey discusses the implications of amendments to the Arms Act for health practitioners in relation to health concerns for patients who have a firearms licence. Amendments to the Arms Act Under amendments to the Arms Act 1983, health practitioners must now consider notifying Police of health concerns related to their patient’s firearms access and will receive a notification from Police when their patient has been issued with a firearms licence. Police notifications to health practitioners From 24 December 2020 all firearms licence applicants (whether they have held a licence previously or not) have been required to supply the name and contact details of their health practitioner to Police.

“All firearms licence applicants (whether they have held a licence previously or not) have been required to supply the name and contact details of their health practitioner to Police.”

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When Police issue a firearms licence, they are required to notify the nominated health practitioner as soon as reasonably practicable that a firearms licence has been issued to their patient. Police will also notify the expiry date of that licence and of any subsequent changes to the licence. This is to make health care practitioners aware that their patient may have access to firearms. This information should be stored in the patient record so it is readily visible whenever the notes are accessed. Information that an individual has a firearms licence is considered sensitive. Therefore, the information must be kept securely, just as all the rest of a person’s health records are secured. When health practitioners need to consider notifying Police Section 92 requires the health practitioner to consider notifying Police as soon as practicable if: •

The health practitioner has attended or been consulted in respect of a person who the practitioner knows or has reason to believe is a firearms licence holder; and


The heath practitioner considers that the health condition of the licence holder is such that, in the interests of the safety of individuals or the public, the licence holder— (a) should not be permitted to use or possess a firearm; or (b) should only be permitted to use or possess a firearm subject to any limitations that may be warranted by the health condition of the licence holder.

“Knows or has reason to believe is a firearms licence holder” How will a health practitioner know if a patient is a firearms licence holder? Health practitioners will only receive licence holder information for new or renewed licences issued from 24 December 2020, and only for patients who have nominated them as their health practitioner (for example, some patients consult with more than one health practitioner). Health practitioners should therefore not assume that their patient is not a firearms licence holder, purely on the basis they have not received a notification from Police. The term “reason to believe” is not defined in the Arms Act 1983. However, it can be interpreted to mean that the health practitioner must form their belief based on facts – the belief need not be proven correct at a later time. Examples of other facts which could lead to a practitioner having reason to believe a patient is a firearms licence holder include: •

notification by the patient themselves that the patient holds a firearms licence

the firearms licence status is recorded in the patient’s medical records

the patient owns, or suggests they have access to firearms, and the practitioner does not have any reason to believe this ownership or access is unlawful, in which case they must be a licence holder.

Certain leisure activities (e.g. membership of a pistol club) or occupations (e.g. wild animal or animal pest controller) would be strongly suggestive of firearm access and/or ownership. Health conditions Health conditions that might lead a practitioner to consider notification are any that, for the interests of the safety of individuals or the public, mean that the licence holder should not be permitted to use or possess a firearm. There is no exhaustive list of health conditions that may be relevant to safe possession and use of firearms. What is important is whether the health condition is developing or manifesting itself (or likely to) in such a way that, in the interests of individual or public safety, the person should not continue to possess firearms (or, should only do so on certain conditions).

Contacting Police The decision to notify Police can sometimes be a difficult one. Practitioners are encouraged to consult with other health practitioners involved in the patient’s care, and they should seek medicolegal advice from their indemnifier, such as the Medical Protection Society (MPS). Any decisions, and the reasons for them, should be carefully documented in the clinical record in case the practitioner(s) are subsequently called upon to justify their action. Information that should be provided Where a health practitioner decides to notify Police, the following information should be provided: •

their opinion – that in the interests of individual or public safety the person should not be permitted to use or possess firearms (or only if subject to certain limitations)

the grounds on which that opinion is based, and whether the practitioner believes that the licence holder poses an immediate or imminent danger of self-harm or harm to others.

The grounds on which that opinion is based may include the nature of the person’s health condition and how that is impacting on, or is likely to impact on, the licence holder and their ability to safely use and possess firearms. If limitations are recommended, explain how those limitations are warranted with reference to the health condition. The only information that should be provided is information relevant to the health practitioner’s opinion. Protection when acting in good faith Under section 92(5) of the Act, health practitioners are not liable to criminal, civil or disciplinary proceedings by disclosing personal information in the course of performing any of the notifications under the new Act, as long as they act in good faith. Other situations where a health practitioner may consider it necessary to provide information to Police The Health Information Privacy Code guides health practitioners on their privacy obligations and should be consulted when considering making reports to Police in other situations (for example, if the safety concern isn’t related to a health condition, or the safety concerns are about a patient who isn’t a licence holder). Decisions to notify are often complex, and guidance should always be sought from your indemnifier, such as MPS, in these circumstances.

WWW.ASMS.ORG.NZ | THE SPECIALIST

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In brief Branch officers summary Sixty-five members, including exec members, branch officers, members in interested in the Māori advisory committee and a handful a members seeking greater involvement in the union, met at the Intercontinental Hotel in Wellington for the annual Branch Officers Hui on the 1st of July. Senior Industrial Officer Steve Hurring talked through the negotiation and settlement of the new MECA as well as starting a conversation about the negotiation of the next SECA at the start of 2023. A “bus stop exercise” saw participants experience a series of rapid-fire presentations covering speaking out, best practice for working with your industrial officer, building a strong branch, job sizing, local JCCs under Te Whatu Ora, local agreements and health and safety at work. Sarah Dalton then presented a summary of ASMS’s latest publication Tooth be told: The case for universal dental care in Aotearoa New Zealand and launched ASMS’s refreshed new website. The night before saw the farewell function for Senior Industrial Officer Henry Stubbs, who has retired after his 28 years with ASMS.

DID YOU KNOW? There are a number of opportunities but also employment implications arising from the merging of the old DHBs into the new single crown entity – Te Whatu Ora Health New Zealand. One consequence is that when you leave employment with a hospital in one district to take up employment in another, you will now be regarded as having transferred. And you will not be regarded as having terminated your employment. A consequence of this is that leave balances and CME funds will no longer be extinguished. Instead, they will be transferred to the new district. This includes: •

annual leave balances

CME leave balances

CME expense balances

Anniversary dates for annual holiday and salary step increment purposes will also transfer.

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Some entitlements already recognise service across multiple districts (e.g. service for sabbatical entitlements). This will continue. Some districts previously restricted access to CME funds in the last three months of employment at a particular DHB. This restriction no longer applies for transferring employees. For the time being, districts will continue to operate their own payroll systems, so there may be technical issues with transferring of balances that require manual intervention. But this should not be a reason for withholding access to leave and CME funds when transferring between districts. If any issues arise, please contact your Industrial Officer.


Haere ra Dr Charlotte Chambers In July, ASMS farewelled Policy and Research Director Dr Charlotte Chambers. With Charlie’s departure, it seemed appropriate to reflect on some of the ‘greatest hits’ of her research and advocacy. Charlie has taken a role at the Ministry of Justice, where she will no doubt continue to harness data to inform equitable change. During her seven years at ASMS, Charlie’s research, advocacy and leadership in matters of importance to our members – burnout, bullying and harassment, and the experiences of our female SMOs – have contributed to a greater understanding and visibility of matters affecting the SMO workforce. The following whakataukī, or Māori proverb, reflects on how the process of research and advocacy supports our collective vision as Toi Mata Hauora | ASMS: Mā te rongo, ka mōhio; Mā te mōhio; ka mārama; Mā te mārama, ka mātau, Mā te mātau ka ora. From listening, comes knowledge. From knowledge, comes understanding; From understanding, comes wisdom. From wisdom, comes wellbeing.

‘Making up for being female’ Work-life balance, medical time and gender norms for women in the New Zealand senior medical workforce (2019) “Data suggests that the wellbeing of women in the New Zealand senior medical workforce is at risk. What is unclear is why.” This project laid bare the experiences of women as they traversed their working lives as senior doctors and their roles as parents, partners and caregivers. The often deeply personal reflections given by research participants offer insights into how gender norms are coded into expectations around working hours and workloads.

Bullying in the New Zealand senior medical workforce: prevalence, correlates and consequences (2017) This study aimed to provide a benchmark of bullying prevalence in the senior medical workforce. At the time little was known about the incidence and experiences of senior doctors and dentists who had been subject to or witnessed bullying. Results were stark: more than a third (37.2%) had experienced bullying; nearly two-thirds (67.5%) had witnessed the bullying of colleagues; and only 6 per cent reported that the behaviour stopped once they had reported it.

Tired, worn out and uncertain: burnout in the New Zealand public hospital senior medical workforce (2016) “My employer is exhausting" Burnout in the senior medical workforce five years on (2021) “Burnout is now an entrenched feature of our specialist medical and dental workforce”: surveys in 2015 and 2021 reported rates of burnout among senior doctors and dentists of 50%, meaning that there has been no substantive improvement during this time. Data gathered during these and other surveys undertaken by Charlie has provided an invaluable data source to inform both advocacy to support the public hospital workforce and our industrial campaigning.

WWW.ASMS.ORG.NZ | THE SPECIALIST

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ASMS Annual Conference 2022 Did you know that ASMS members can attend ASMS Annual Conference on full pay. This year with be ASMS’s 34th Annual Conference and it will be held in Wellington on Thursday the 24th and Friday the 25th of November. ASMS members who wish to attend can complete a registration form at www.asms.org.nz/event/asms-annual-conference. After Executive members and Branch Officers, any member is entitled to attend – subject to capacity limitations. What is more, if you are covered by the MECA, under clause 29 you are entitled to leave on full pay to attend. All costs of travel and accommodation are paid by ASMS. So, if you would like to join us in late November, fill in the form. And if you would like more information talk to your industrial officer or ASMS branch representative, or contact the support team at events@asms.org.nz. It is also important to give your employer early notice. And be aware that MECA clause 29 provides for its own category of leave - you do not need to use CME leave. The theme of this year’s conference is “Will We Get Better?”. The programme will include speakers on the real cost of our health system and workforce development as well as a speech from the Minister of Health, and a presentation from doctor and filmmaker Paul Trotman. On the evening of Wednesday 23 November there will a be a pre-conference function at the New Zealand Academy of Fine Arts to open the second annual doctors and dentists art exhibition.

ASMS welcomes some new staff… GEORGIA BATES Industrial Officer

GREG LLOYD Industrial Officer Georgia is excited to have recently joined ASMS in a part-time role and will be based primarily in the Waitematā District.

Holding a joint Bachelor of Law and Arts degree from the University of Auckland, she has spent the past 15 years working in a range of private legal practices, corporate consulting roles and inhouse legal work for public sector unions. “What gets me out of bed in the morning is a desire to contribute and make things better – building connections, improving the experiences and wellbeing of others, and acting with integrity,” she says. Georgia is looking forward to applying her skills in a new environment. “I have provided front-end advisory, dispute resolution and advocacy services for a range of public and private sector clients, as well as conducting complex internal investigations and handling whistleblower reports. I can’t wait to meet some new people, start using that experience and get into it.”

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THE SPECIALIST | SEPTEMBER 2022

MATT SHAND Journalist/Communications Advisor Greg is the new industrial officer for the Hawkes Bay, Wairarapa, Tairāwhiti and West Coast and comes from a strong legal and union background.

Greg spent the past five years working as a barrister. Before that he was General Counsel for the Engineering, Printing and Manufacturing Union. Greg has worked for other unions, as well as the Department of Labour, in his 20+ year legal career. “I’ve worked with ASMS before on cases and always felt it was a strong and professional union with its members’ needs at the core of what it does,” says Greg. Greg feels his time as a lawyer gives him a different perspective on his job. “Part of the enjoyment for me in this role will be finding ways to avoid legal disputes through problem solving and advocacy, rather than being the ambulance at the bottom of the cliff.” “I’m very much looking forward to heading out to the hospitals, getting into all the regions and meeting our members.”

Matt has been a journalist for more than 10 years in Australia and New Zealand and recently moved into the public health space. His journalistic claims to fame include being the dumpster diver that located the NZ First Foundation donation documents and reporting on the dysfunction at Tauranga City Council which has seen the elected councillors replaced by commissioners. Just prior to joining ASMS, Matt worked at The Helen Clark Foundation and Health Coalition Aotearoa on a range of topics relating to public health - mainly alcohol, tobacco and fast food. Matt says his experience at the frontlines of journalism has taught him the importance of speaking out. “But often people struggle to find their voice at key moments. It’s a powerful thing to help others find their voice.” Matt says it is often difficult for journalists to get access to information for health stories and he wants to use his experience to help open access to data and sources at the front lines.


The Art of Medicine… and Dentistry 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. Already 2022 looks to be significantly larger than last year’s. But there is still a chance for anyone interested to submit work. It is open to hospital 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. It will open on 23 November with a gala event to coincide with the ASMS Annual Conference and will run for nine days. 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. If you would like to submit something, please contact our industrial officer Lloyd Woods at lloyd.woods@asms.org.nz

ASMS staff Executive Director Sarah Dalton Communications Senior Communications Advisor Andrew Chick Journalist | Communications Advisor Matt Shand Industrial Senior Industrial Officer Steve Hurring Senior Industrial Officer Lloyd Woods Senior Industrial Officer Ian Weir-Smith Industrial Officer David Kettley Industrial Officer George Collins

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.

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

As a union of professionals, we:

Postal address: PO Box 10763, The Terrace, Wellington 6143

• provide advice to salaried doctors and dentists who receive a job offer from a New Zealand employer

P 04 499 1271 E asms@asms.org.nz W www.asms.org.nz

• 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

Follow us

• 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

facebook.com/asms.nz twitter.com/ASMSNZ Have you changed address or phone number recently? Please email any changes to your contact details to: asms@asms.org.nz 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 sarah.dalton@asms.org.nz

Industrial Officer Kris Smith Industrial Officer Georgia Choveaux Industrial Officer Jenny Chapman Industrial Officer Tanja Bristow Industrial Officer Georgia Bates Industrial Officer Greg Lloyd Policy & Research Director of Policy and Research Harriet Wild Policy Advisor Mary Harvey Health Policy Analyst Lyndon Keene Manager Support Services Sharlene Lawrence Membership Officer Saasha Mason 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 asms@asms.org.nz

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