Dr Dean Boddington’s letter to Te Whatu Ora: Bureaucrats need to open their eyes

Dr Dean Boddington is a cardiologist at Tauranga Hospital and a member of the Association of Salaried Medical Specialists union. Photo / Alex Cairns

Tauranga Hospital cardiologist Dr Dean Boddington spoke out about what he believes to be New Zealand’s “abusive” health system ahead of the first Association of Salaried Medical Specialists (ASMS) strike. Nearly three weeks later, with settlement negotiations between Te Whatu Ora - Health New Zealand and the union at an impasse, he writes an open letter to his employer and the public.

OPINION

I am deeply disappointed that I am having to make a second statement to the media regarding our dispute with our employer Te Whatu Ora.

I was probably naïve in my thinking that our limited strike action to date would bring the executive team of Te Whatu Ora to their senses. Sadly, this is clearly not the case.

Workforce retention is the single biggest issue facing healthcare in NZ, and Te Whatu Ora does not appear to get that.

Instead, in my view it has embarked on a campaign to try to undermine and discredit medical specialists rather than do what is required. The approach is in keeping with opposing political parties, rather than working with the team that we are supposed to be. Divide and conquer appears to be the tactic deployed.

I believe Te Whatu Ora tried to deliberately mislead the public by presenting inaccurate information about our salaries. The figures they quoted represent what it is possible for specialists to earn, if they are at the top of the salary scale, work fulltime and do many after-hours of work. The reality is the vast majority of us do not earn anywhere near those figures. If one were to earn the top end of the salaries they quoted, it would entail many on-calls and many after-hours of work. It would probably require working around 60 hours a week to earn the top salary they have portrayed. We do not want to be working those hours. We are tired of covering for staff shortages. We also have families we would like to spend time with.

Let us consider the salaries of the executive leadership team of Te Whatu Ora. Margie Apa provided information about their salary bands when requested to do so under the Official Information Act in July this year. The senior executive team members can earn between $438,400 per year and $770,000 per year.

In my opinion, they are overpaid, yet want to impose austerity packages on all healthcare workers, including the ASMS members. I believe this is hypocrisy of the highest order, and it comes whilst we, the doctors, have to work long hours, including many sleepless nights, and weekend duties.

I would like to refer to an article by Rob Campbell (NZ Herald, September 22), and I suggest that everybody read this landmark article. Credit and respect to Rob for the honesty and integrity he has demonstrated in his article. Sadly, he is no longer with Te Whatu Ora, probably because he tried to rock the boat of the bureaucrats. In brief, Rob apologised to healthcare workers and admitted that he failed in his role because he was too nice to the bureaucrats. I applaud Rob for having been willing to step forward in the way that he has regarding the NZ healthcare system.

Rob Campbell, former chairman of Te Whatu Ora. Photo / Michael Craig

In his article, Rob confirmed the suspicion that I have always had, which is that the leaders of our healthcare system are working with management models that I believe should not be applied to the health system. Change to the system was needed, and forming Te Whatu Ora was meant to be part of that. Te Whatu Ora has, however, continued with inappropriate models, with no significant change in their thinking. In addition, in my view, they have not sufficiently engaged with the people that actually deliver the service, like they are supposed to. I believe there is a big disincentive in place for them to change the system dramatically, as it might put their huge salaries in jeopardy. They have failed to recognise that their current model of operating does not work and requires different thinking. There is a need for them to go to Government to request an adjustment be made to the funding that is given to healthcare.

The organisation or model in place puts bureaucrats in charge of a health service that is delivered by medical, nursing and allied health personnel. The workers who do the work are professionals with a life-long dedication to their work, which is to try to make people’s health better. This goodwill by all of these employees has been taken advantage of for far too long, and this has to stop. Te Whatu Ora bureaucrats seem only to have one priority in mind, and that is to work within their budget. In doing so, they seem happy to squeeze all of their employees. They rely on the fact that healthcare workers feel terrible when they let their patients down in any way by not being there. All of the healthcare workers are working extra shifts and going above and beyond the call of duty to keep the healthcare system running. These healthcare workers, ASMS members included, are taking the strain and moving towards burnout.

Senior doctors like myself who have been working in the system for decades have all seen many district health board chief executives come and go. They get paid huge salaries to operate within budget, they squeeze all the employees for a few years, and then they leave. These bureaucrats have had no long-term vision because they know that they are not going to be there in the future. They have no skin in the game. Some of these former DHB leaders are now running Te Whatu Ora and have taken their same lack of vision with them.

ASMS union members on strike on September 5. Photo / Andrew Warner

Successive governments have failed to address the increase in budget that healthcare requires. Whichever government comes into power in October needs to bring new thinking with a long-term vision, rather than looking only as far ahead as the next election. Government and Te Whatu Ora are to be held jointly accountable. It is a responsibility of the Ministry of Health to step in when required, and the Ministry of Health has failed us over time. The first priority that bureaucratic former DHB chief executives and now Te Whatu Ora executives should have is to be appealing to Government for the extra funding required, rather than trying to make it work by squeezing employees. If the budget Te Whatu Ora is given is not sufficient to meet the requirements of the healthcare system and to provide salaries that enable retention of workers, then the Te Whatu Ora executive has a moral and ethical obligation to appeal to the government of the day for more funding.

The Te Whatu Ora executive appears to have not heard a single word any of the ASMS members have expressed. In my opinion, they blindly and stubbornly continue on their destructive path of trying to undermine and discredit doctors and batter us into submission. We have finally stood up for ourselves, and we will not back down. I cannot see the logic in the thinking of the Te Whatu Ora executive. If they do batter us into submission and we accept a lesser offer than what we have requested, then they will be left with a deeply disillusioned workforce. They may think that is a win for them, but ultimately, it will be a loss to the healthcare of NZ when many of those specialists start walking away.

Te Whatu Ora has tried to label the senior doctors as being money-hungry, when all we are asking for is a very modest salary increase that does not quite keep up with inflation. Most of us doctors earn far less than what they say we do. The reason the salaries need to go up is workforce retention. If the salaries in NZ keep falling behind as they have done, then the system will continue to lose highly trained and skilled specialists to the private sector and to other countries, particularly Australia. The requested salary increase by ASMS falls far short of what is actually required to address the workforce retention issues. What we have requested is the bare minimum required to keep the workers we currently have.

What this strike process represents is senior doctors sending a message to the Te Whatu Ora executive. This is a vote of no confidence in their leadership. That message can be passed on up the chain to the Ministry of Health and incumbent Government. The Te Whatu Ora executive team has taken us for granted, disrespected us and shown us that they clearly do not value our services. Senior doctors have never gone on strike before because of our inbuilt desire to always do right by our patients. We are in the trenches with the patients and go through their suffering with them. We feel their pain, and it weighs on us. All of us have sleepless nights and ongoing anxiety and stress when patients do not receive the care they need in a timely manner. This process of striking makes us feel dirtied and diminished, and brings huge amounts of guilt for the disruption to patient care. We did not want to do this, but felt that in the long-term, we have to go on strike to create awareness of the failing system. If we do not take action now, then the system is in danger of collapsing and becoming a service that fails to meet the needs of the public. This would ultimately harm patients far more than the disruption caused by the strikes.

On behalf of the senior doctors of NZ, I would like to apologise to the public of NZ for the disruption caused by the strike action. I can assure you this weighs very heavily on us. We care deeply about our patients and we want a sustainable workforce to care for the future needs of our patients. We have done this as a last resort to prevent the disintegration of the healthcare service in NZ. We will carry mental scars from this process. It would be easier to do what many have done and just leave, but our commitment to patient care means we have to make a stand.

Our message to the executive team of Te Whatu Ora: Come to your senses, please. You have already lost the respect of the senior doctors and are in the process of losing our trust. These are not things that are easily regained. Continuing along the path that you have chosen will have profound and destructive consequences. Open your eyes and see what is happening, or resign and let somebody with more vision do the job. Bureaucrats are easily replaced. We have already seen that the many healthcare workers who have left will be extremely difficult to replace.

Dr Dean Boddington is a cardiologist at Tauranga Hospital and a member of the Association of Salaried Medical Specialists union.