We have a largely privatised health system with a mix of public funding, insurance money, private investment and philanthropic contribution. But with the right political and executive leadership, there can be a clear objective.
Opinion: Sometimes relatively small issues encapsulate and illustrate wider problems. A current pay and conditions dispute in the health system is one of those. Like so many issues in that system this one has a long background, reflects widespread hypocrisy and ineffective management, harms health outcomes and drives stress and despair among staff and exacerbates one of the biggest challenges.
Medical labs are an essential organ of the health system. Many were stupidly privatised years ago, others still operate within Te Whatu Ora with all the resource shortages and stress that go with that. There was a view that competition in medical labs would produce greater efficiency but it has actually produced a mess.
Incredibly there is no National Pathology Strategy for the system nor a genuine leadership of this critical function. Past tinkering chasing illusory cost savings, coupled with inadequate planning, contracting and management have created this mess, among many.
READ MORE:
* ‘Under pressure’: Verrall’s weekly reports unveil hospital plight
* A diagnosis for an ailing health sector
* Verrall flexes health system's muscles
* Aged care 'deliberately' underfunded
For months now lab staff employed by one of the private providers have been negotiating and striking to get better pay and working conditions.
For reference a medical lab scientist with a four-year degree and eight years of experience tops out at $80,000 a year with no further progression working for this privately owned provider.
Pay is 8 percent behind Te Whatu Ora rates, which are currently themselves being renegotiated.
Strip away some blather about efficiency and flexibility and you find a system which is at best lethargic and always happy to see costs kept low at the expense of often already low-paid workers
The provider (Awanui) is owned by private equity in combination with, mainly, NZ Super. Its directors include a person who chairs the committee overseeing progress in the Pae Ora reforms. It is profitable, owners having taken tens of millions out of the business in recent years and spending tens of millions recently on buyouts and rebranding. (Note, there are lots of private investors making good money out of the public health system.)
But Awanui has been stubbornly resisting lifting employment conditions and pay to anything that matches Te Whatu Ora standards.
You may ask what Te Whatu Ora has been doing about this and the answer is … nothing – or at least nothing useful. Even though the business is totally dependent on public funding, it is allowed to continue to underpay.
This is not uncommon. For many services (catering is an obvious one) there are fully or partially contracted out arrangements where pay and conditions often lag and staff face lengthy and stressful delays playing catch up. In my own experience in Te Whatu Ora, management was loth to do anything to ensure appropriate employment standards were maintained among such contractors.
Strip away some blather about efficiency and flexibility and you find a system which is at best lethargic and always happy to see costs kept low at the expense of often already low-paid workers.
You might have thought that Te Mauri o Rongo (The Health Charter) which governs these matters would set the standards. Well, it should. The charter applies to all “organisations and workers involved in delivering publicly funded services”. The provisions emphasise positive working conditions and relations working together with staff and unions.
None of those high principles have been evident in this laboratory relationship. Most recently management at Awanui has been stepping right across the “Code of Good Faith For The Public Health Sector” in its persistent efforts to prevent staff from exercising their right to strike.
In addition to pay there are real staff safety and patient service quality issues as Awanui rationalises services affecting smaller regional labs in particular. Again without any effective Te Whatu Ora intervention. One can only hope there is some strong direction given to Awanui as they enter into facilitated bargaining soon to resolve the specific disputes.
But even such resolution, welcome relief though it would be to those involved, would leave the bigger problems unresolved. We have chosen to evolve a largely privatised health system supported by a mix of public funding, insurance money, private investment and philanthropic contribution. Even the largest genuinely public delivery part of the system gradually loses ground as a proportion of health services through neglect, low funding and inefficiency.
There are arguments for and against each part of this mix, as well as the mix itself. Right now, with the various crises across the system, there is not much point in debating this. The current issue is how best to make this work. Sufficiency in an imperfect world. Pae Ora was a grand endeavour to do this but its methods, coverage, process, theory and delivery are faulty. It can be made to work without a full revision – sufficiency with imperfection.
Diverse agencies to deliver this can be a clear objective and with the right political and executive leadership it can be done. That requires specific priorities, standards and targets that enable action, backed by funding. These cannot be set by the agents of past systems constantly rewriting tomes of inaction. Nor by ignoring funded agencies undermining standards. At present too much lacks accountability to get the benefits that diverse agencies can bring to a common cause.
The main policy themes are not contentious, only getting things done. It has to be done in a context that fully recognises the mix I have described with clarity as to what is expected of each. Only that way can working together be possible.
This is the macro-direction we need now. Within that the array of specific issues like those between Awanui and its staff can be readily fixed. But left without effective direction they will multiply.
I back the Awanui staff, and all those working in a frustrating and stressful situation because the leadership is not adequate.
