John Roughan: More blood will be spilt when doctors go to war

When the medical profession mobilises for a political purpose it is a terrible force. The battle of the Auckland blood tests is becoming epic.

A previous generation of doctors fought off frequent attempts to control their fees and succeeded in resisting the full embrace of the welfare state. This generation of the profession finds the threat to its power coming from the opposite direction.

Economic liberalism demands balanced budgets and competitive public services. In the 1990s doctors became adept at generating public fear of funding cuts and service rationing in their field. Governments grumbled that they were "shroud waving" but it worked.

Today public health spending is still rising faster than the country's economic output, exceeding national income growth by much more than in other developed countries with aging populations.

But still doctors see business managers, "bean counters", sitting on boards that doctors used to dominate and they don't like it.

By rights the battle of the Auckland blood tests was won last year when the Court of Appeal ruled there was nothing wrong with the way three district health boards had decided to transfer their joint contract to a laboratory that offered a public saving.

The ruling was the culmination of a long campaign that featured a conflict of interest accusation against the original leader of the successful bid and the old presumptions of the medical fraternity that its preferences are paramount.

But the judgment did not deter the losing incumbent and its supporting doctors, who moved their case from the courtroom to the media and, more latterly to the streets.

The preparations for the hand-over last month were accompanied by continued attempts to white-ant the newcomer, Labtests NZ Ltd, and the caterwauling has only increased since Labtests began testing on August 10.

One day the dismissed contractor, Diagnostic MedLab Ltd, even put a film crew outside Labtests collection centres to interview patients. Edited high-lights, ridiculously one-sided, were aired by TVNZ this week.

Meanwhile, the medical profession is coming up with more subtle stunts. An Auckland primary health organisation, Procare Network North, let it be known on Wednesday that it will pay its member practices to take blood samples themselves, implying Labtests is not coping.

It said it would pay for the blood collection with public funds provided for purposes of improving the health of Maori, Pacific Islanders and the poor. Implication: see who suffers when bean-counters try to save money?

The PHO made this pointed gesture without reference to Labtests or the district health board, according to Labtests chief executive, UIf Lindskog, who said his operation doesn't need its help.

The next day he faced the heavyweights. The NZ Medical Association declared Auckland's new blood testing service "unacceptable" and asked the Government to step in.

NZMA chairman, Dr Peter Foley said the fact that Procare Network North had committed funds to pay GP clinics to collect blood showed the "despair" of doctors. Give me a break.

The medical profession's political power should not be under-estimated. When the first Labour Government wanted to make free healthcare a cornerstone of Social Security not even the popularity of Michael Joseph Savage could match doctors' public cachet.

Helen Clark was the last Labour minister of health to make a frontal assault on their financial independence and fail.

As Prime Minister she managed to introduce a more subtle method of socialising primary care. Doctors would be funded according to the number of patients enrolled in their practice rather than the visits patients made. Procare's little stunt this week has shown how easily the funds can be misused.

Auckland's blood could be the decisive battleground in the conflict between medicine and economic management. I have not been to a Labtests collection clinic but I have experienced the previous set-up. It was wonderful.

Anytime I was sent for a test I'd find two or three nurses on hand, nobody waiting, the test would be done with no fuss and I'd be out of there in a few minutes. It was better than it needed to be, a service ripe for public savings.

Labtests is operating with about 25 fewer collection centres and doubtless there is often a wait.

Doctors' outrage at this is richly amusing. Their waiting rooms are well- named. No profession is more careless about the appointments its customers have met.

By rights they should not win this battle but history suggests they will. They will keep up the political pressure until the Government gets worried and Labtests quietly sacrifices the savings it promised.

As always doctors say they are seeking only the best for patients. Even the right to charge a fee was presented as essential to their "relationship" with patients.

The Hippocratic heritage obliged them to serve individuals, not the economics of public health.

That is the trouble.