Speaker 1: Kilda. I'm Chelsea Daniels and this is the Front Page,
Speaker 1: a daily podcast presented by the New Zealand Herald. Thousands
Speaker 1: of senior doctors are on strike until midnight tonight after
Speaker 1: walking off the job yesterday. Their long running pay dispute
Speaker 1: with Health New Zealand continues, with doctors saying the latest
Speaker 1: offer represents a real pay cut when recruitment and retention
Speaker 1: is critical. Meanwhile, Health Minister Simeon Brown claims they're putting
Speaker 1: pay and politics ahead of patients after thousands of elective
Speaker 1: procedures and appointments have been postponed. So what will end
Speaker 1: this cycle of disputes and strikes and how do we
Speaker 1: fix our health system that's been in crisis for decades.
Speaker 1: Today on the Front Page, Asms Executive Director Sarah Dalton
Speaker 1: is with us to break down the latest in talks
Speaker 1: and what we can do in future. What are the
Speaker 1: main issues driving senior doctors and dentists to strike and
Speaker 1: how long have talks with the Health New Zealand has
Speaker 1: been stalled.
Speaker 2: There are really two big parts I think to the
Speaker 2: strike action for our members. One is the staffing shortages
Speaker 2: and the other is the fact that Health New Zealand
Speaker 2: has continued to offer real terms pay cuts to our
Speaker 2: members year on year since COVID. So on the one hand,
Speaker 2: everyone acknowledges there are significant staff and gaps and a
Speaker 2: number of specialties and a number of hospitals around New Zealand.
Speaker 2: But on the other hand, knowing this, health New Zealand
Speaker 2: appears to be doing nothing to address retention or recruitment.
Speaker 2: And the obvious way to deal with retention and recruitment
Speaker 2: is through better terms and conditions, right, And I guess
Speaker 2: the other frustration is that while they're crying poor and
Speaker 2: saying that we've got We've given you all the money
Speaker 2: we possibly can, we have nothing more to offer to
Speaker 2: settle terms and conditions for salary to doctors and dentists.
Speaker 2: Just in the last twelve months they shelled out over
Speaker 2: two hundred million dollars on locums, which is effectively tempts.
Speaker 2: You know, So they do have money, they're just choosing
Speaker 2: to spend it in interesting ways.
Speaker 1: And what are some of those interesting ways?
Speaker 3: Well, for example, why would you prioritize.
Speaker 2: Letting locum rates go up and up and up for
Speaker 2: temporary labor who, of course do a good job, but
Speaker 2: they don't do the whole job, and they're not here
Speaker 2: for the long haul. While at the same time you're
Speaker 2: saying to a salary doctor, no, we're not going to
Speaker 2: pay you a retention allowance for working in Gisbon or
Speaker 2: in Vicago, or we're not going to pay a recruitment
Speaker 2: allowance for guyne oncologists because there are hardly any left
Speaker 2: in this country that it would be actually cheaper for
Speaker 2: Health New Zealand and better for the public if they
Speaker 2: incentivize salaried work and disincentivized locan work. So the story
Speaker 2: was that, you know, under twenty DHBs they could drive
Speaker 2: up the rates, you know, by one hospital competing against
Speaker 2: another for locums. Yet under a single employer they have
Speaker 2: driven up the rates as a single employer for locums.
Speaker 2: So you can earn a huge amount of money by saying, look,
Speaker 2: I'll volunteer to go and work in this place for
Speaker 2: a week or over a weekend or whatever. Yet the
Speaker 2: people who are there all of the time, running the department,
Speaker 2: doing the planning, doing the audit, supervising other staff are
Speaker 2: earning significantly less.
Speaker 3: So it does seem a little bit back to front.
Speaker 1: Yeah, I was going to say, do a lot of
Speaker 1: people just forego the salaried work and just go and
Speaker 1: be like, yeah, I'll do the casual loco work.
Speaker 3: Well, that's starting to be the case, and that is
Speaker 3: what our real worry is. It is already a real
Speaker 3: trend in psychiatry where there are massive staff and gaps
Speaker 3: and a number of services will have more locums than
Speaker 3: salaried specialists on staff now and that's terrible, particularly because
Speaker 3: in mental health you're often looking for continuity of care.
Speaker 3: You are looking for the people that are in the
Speaker 3: care of our specialist mental health services. You know they
Speaker 3: do better when they have stable staff who are there
Speaker 3: to get to know them and work with them. And
Speaker 3: I'm not trying to diss the people who are working
Speaker 3: as locums. We know they're doing valuable work and we
Speaker 3: know that there are a lot of places that can
Speaker 3: you have to rely on them because of decisions made
Speaker 3: by DHBs and Health New Zealand about lower and the
Speaker 3: staffing levels. Effectively, we see there's been a sink England
Speaker 3: on staffing for some time.
Speaker 1: How do senior doctors respond to the claims that their
Speaker 1: action amounts to quote, putting pay and politics ahead of patients.
Speaker 1: That's suggested by the Health minister.
Speaker 3: Well, that's his job, isn't it. You know, he's a politician.
Speaker 3: He's playing politics, and that's fine. But our members aren't politicians.
Speaker 3: They're doctors.
Speaker 2: It's really hard for them to take strike action because
Speaker 2: they are trying to put patients first. They are trained
Speaker 2: not to walk away from people who need care. But
Speaker 2: it has reached the point now that the health system
Speaker 2: is actually on a daily basis preventing them from giving
Speaker 2: people the care they need. I guess the term that
Speaker 2: academics use for this is moral injury, the injury that
Speaker 2: you suffer when you're actually prevented from doing the work
Speaker 2: that you're trained to do in the way and so
Speaker 2: our members spend a lot of time trying to do
Speaker 2: the least worst thing for patients rather than the best thing.
Speaker 1: This understaffing and the health crisis that we talk about
Speaker 1: has been going on for successive governments. How do we
Speaker 1: put an end to it fair and square, Because I'm
Speaker 1: pretty sure that a majority of the public wouldn't mind
Speaker 1: tax dollars going towards our health system because that's where
Speaker 1: we go when we you know, we're at our most
Speaker 1: vulnerable and we need the most help, right, So how
Speaker 1: does this?
Speaker 3: How do we stop this?
Speaker 2: I think that's a really great question. I mean, this government,
Speaker 2: this particular government, loves targets. We don't love the targets
Speaker 2: they've picked. But if they want to obsess about targets,
Speaker 2: how about a workforce target or two to go alongside
Speaker 2: the care.
Speaker 3: Targets, because it's I think it's another thing.
Speaker 2: You know, it's really hard for hospital staff when they
Speaker 2: know they're really short staffed, and then they've given all
Speaker 2: these supposed productivity targets, performance targets that they have to
Speaker 2: meet when they know that there's no way that that.
Speaker 3: Can realistically happen. So some workforce targets would be great.
Speaker 3: And then I think there needs to be some multi
Speaker 3: party agreements about the kind of hospital system, the kind
Speaker 3: of health system that New Zealand is willing to continue
Speaker 3: to fund and to provide. And if we've got some
Speaker 3: multi party buy into some health basics, you know, and
Speaker 3: even health basics are pretty expensive, defining what our health basics?
Speaker 3: Does that include.
Speaker 2: Hips, does that include age, residential care, does it include
Speaker 2: dentistry which it currently does, and of course you know
Speaker 2: what services does it include?
Speaker 3: What have people got a right to expect and then
Speaker 3: we could You know, there are people out there that
Speaker 3: know how to calculate what level of resource, what level
Speaker 3: of staffing is required, and obviously for a number of
Speaker 3: people now the question needs to be asked, how close
Speaker 3: to home can your care be provided. You know, there's
Speaker 3: a massive growth of Tallyhealth. That's a great supplement to
Speaker 3: other kinds of healthcare. But if that's all you're being
Speaker 3: offered because you happen to live rurally, or because where
Speaker 3: you live all of the GP practices are full and
Speaker 3: they're not taking more patients, it is a poor second
Speaker 3: to face to face care. And I'm not trying to
Speaker 3: diss tallyhealth and it has its place, but simply as
Speaker 3: a substitute for in person care, I don't think that's
Speaker 3: good enough. I don't think that's what New Zealanders expect
Speaker 3: their tax dollars to buy. And again, it's a privatized
Speaker 3: way of providing care because most of that care is
Speaker 3: contracted out. So you know, we've put out a recent
Speaker 3: report about how health has been funded. We know that
Speaker 3: since twenty eighteen, New Zealand has not been submitting its
Speaker 3: health resource and data to the OECD. So all of
Speaker 3: the comparators that are made between us in like countries
Speaker 3: are rough guesses, they're rough estimates, and they're overestimates because
Speaker 3: we've also been including GST in the way health spend
Speaker 3: has been costed, which other countries don't do, so we've
Speaker 3: been overinflating what's been spent on health in this country.
Speaker 3: And also now we no longer seem to have the
Speaker 3: capability within the Ministry of Health to submit the data
Speaker 3: for international comparisons. They just seem so fundamental, and it
Speaker 3: took this recent report that we commission to uncover that
Speaker 3: people didn't know that that was no longer happening. So
Speaker 3: we've got some really fundamental things that need to be rethought,
Speaker 3: I think, by government, by the policy people who advise government,
Speaker 3: and I think now is a great time for.
Speaker 2: People, through community groups and just speaking up directly to
Speaker 2: let government and opposition know what kind of health system
Speaker 2: we want, we expect.
Speaker 4: You know, senior doctors are wanting to strike. That's going
Speaker 4: to cause grief to thirteen thousand patients this week, which
Speaker 4: I don't think is very fair.
Speaker 3: But but hang on, they're striking for a reason, right,
Speaker 3: They don't just do that on a whim.
Speaker 4: No sure, but but what they are doing is that
Speaker 4: they've had a year of negotiations. The Minister said, let's
Speaker 4: get this resolved after a year, let's go to binding arbitration.
Speaker 4: That was rejected outright and as a result they're going
Speaker 4: through to strike. I mean, you just have to remember
Speaker 4: these are some of the most well paid public servants
Speaker 4: we have in the country. You know, they've put another
Speaker 4: offer from healthyw Zealand on top, just recently another one
Speaker 4: hundred and sixty million dollars of taxpayer funding to get
Speaker 4: five and a half thousand senior doctors contracts resolved. Our
Speaker 4: viewers stay in the bargaining process, go into strikes.
Speaker 1: The Minister's also pointed to the average renumeration of senior
Speaker 1: doctors that's just over three hundred and forty three thousand
Speaker 1: dollars six weeks and you'll leave in a fully paid
Speaker 1: six months sabbatical every six years. Now, this wouldn't be
Speaker 1: the first time that we've seen a minister conflate figures
Speaker 1: like this. Would you agree?
Speaker 2: Well, I don't agree, and I'll start with it's a
Speaker 2: three month sabbatical after every six years. And many members
Speaker 2: wrote to us last time he bandied about that three
Speaker 2: hundred and forty seven thousand dollars number in Setif I
Speaker 2: was earning that much money, I would not be going
Speaker 2: on strike. I would not be concerned about where this
Speaker 2: is going. And I think it's also another cheap line
Speaker 2: that politicians and some health leaders like to use, is oh, well,
Speaker 2: there are international medical workforce shortages. You know, we're in
Speaker 2: a competitor international markets, So what can we do well,
Speaker 2: do more than you're doing at the moment. Don't slag
Speaker 2: off those specialists who we need. Think about what it
Speaker 2: is New Zealand can do. If we can't match Australian salaries,
Speaker 2: what could we do that would make people want to
Speaker 2: stay here or want to come here instead of going
Speaker 2: to Australia. Because you know, nearly fifty percent of our
Speaker 2: medical senior medical workforce comes from overseas, so we have
Speaker 2: to be thoughtful about how we continue to attract those
Speaker 2: people and keep them here because we have a heavy
Speaker 2: reliance on them. We could not run our health system
Speaker 2: without those people. So the long term solution is to
Speaker 2: train more doctors in New Zealand, but that's it'll be
Speaker 2: a lot, very long time.
Speaker 3: If ever, that we train enough of.
Speaker 2: Our own senior doctors and dentists here, So if we
Speaker 2: can't match Australian salaries, what could we do differently? Oh,
Speaker 2: we could staff really generously, right, So you know a
Speaker 2: lot of our members when I talked to them, they said,
Speaker 2: you know, I don't used to mind that we were
Speaker 2: relatively poorly paid. But the Australian comparison is an important
Speaker 2: one because so many of them are in Australasian colleges,
Speaker 2: so they train with groups of people who disperse across
Speaker 2: both countries, so they're on chatting terms with a lot
Speaker 2: of people working in Australia. I didn't used to mind
Speaker 2: that they earned so much more than us because I
Speaker 2: had a great work life balance, I had lots of colleagues,
Speaker 2: I had interesting, challenging work, and people listened to us
Speaker 2: and they valued our views on how to better run
Speaker 2: our service, how to better run our hospital, how to
Speaker 2: better serve our community. Now they feel like they're not heard,
Speaker 2: they are sanctioned if they speak out. They don't have
Speaker 2: enough colleagues. They are really tired, lots of burnout, and
Speaker 2: they're like, no one listens to me anymore, So I
Speaker 2: may as well chase more money because there's nothing else left.
Speaker 2: That is a terrible situation for us to have put
Speaker 2: those people in. But that is, you know, that is
Speaker 2: what they will say.
Speaker 1: What's next, Sarah?
Speaker 3: Look, what I.
Speaker 2: Really hope is that we can get some more I
Speaker 2: was going to say more intelligent engagement across the table obviously,
Speaker 2: which sounds harsh, but it's been pretty empty right. The
Speaker 2: only times Health New Zealand has brought even brought an
Speaker 2: offer to the table, let alone improve it is when
Speaker 2: we've called strike action. Now, that's pretty blunt and pretty basic.
Speaker 2: We would have liked to have had senior enough people
Speaker 2: across the table right from the start to work through
Speaker 2: issues with us. Can we talk about staffing levels? Can
Speaker 2: we talk about where your workforce planning is at? Can
Speaker 2: we talk about where our collective agreement, where our negotiations
Speaker 2: fit into that and the short and the medium term.
Speaker 2: Can we have a conversation about that. Can we have
Speaker 2: some commitments that we can take to our members that
Speaker 2: say we can you know, we can give you this
Speaker 2: now and that later.
Speaker 3: Is that good enough? We don't get that.
Speaker 2: We get you can have this much, but no more.
Speaker 2: And also if we give you this much. Don't tell
Speaker 2: the others because they'll want it to like it's real
Speaker 2: kindergarten stuff, or they'll say and to make up the
Speaker 2: difference because they don't want to They don't want to
Speaker 2: include a settlement that covers the year we've been em bargaining,
Speaker 2: so no backdating. Effectively, they're saying, instead of that, here's
Speaker 2: a lump of money, spend it how you like.
Speaker 3: Now, that is not what I would call quality negotiations
Speaker 3: what I would like them to do.
Speaker 2: And when we came back the other day and said, well,
Speaker 2: continuing medical education, it's really important for specialists to maintain
Speaker 2: currency of their knowledge. That fund, which is to reimburse
Speaker 2: doctors for the costs of attending conferences, doing courses, making
Speaker 2: sure that their.
Speaker 3: Knowledge is up to date.
Speaker 2: That amount hasn't gone up since about two thousand and nine.
Speaker 2: How about we put a bit more money into that
Speaker 2: And they said, oh, oh no, we don't think we
Speaker 2: could do that, you know, or we'd have to.
Speaker 3: Go and check. It's like, well, go and check then,
Speaker 3: you know, go and check now. And I'm consumed because
Speaker 3: it sounds like I'm bargaining through the media now and
Speaker 3: I don't want to do that, but it isn't.
Speaker 2: It's just very frustrating, you know when we actually would
Speaker 2: like to have a conversation of like, you don't want
Speaker 2: to put money on seeing me, can you talk to
Speaker 2: us about why that is? And you know you don't
Speaker 2: want to increase your contribution to superannuation. We know one
Speaker 2: of the reasons they don't want to, so they make
Speaker 2: a six percent up to a six percent contribution super
Speaker 2: is one of the strongest retention things an employer can do,
Speaker 2: right because it's a shared commitment to sticking around, and
Speaker 2: they don't want to do it because they don't offer
Speaker 2: six percent to nurses or allied health workers or admin
Speaker 2: staff in Health New Zealand. Again, it's like, oh, if
Speaker 2: you have that, other people will want it. We don't
Speaker 2: want to give it to them. Why don't you want
Speaker 2: to give it to them? They're holding a health system up.
Speaker 2: You should be offering to match all of our health
Speaker 2: workers superannuation to whatever the key we say the maximum is.
Speaker 2: I think it might be up around ten percent. Now,
Speaker 2: why don't.
Speaker 3: You do that? It's only a cost of people choose
Speaker 3: to contribute that much themselves and it shows value. But
Speaker 3: we're not having that kind of a conversation. It's a
Speaker 3: scraping the bottom of the barrel kind of a conversation,
Speaker 3: you know, And what's the least we can do to
Speaker 3: make you stop this? That's pretty much the vibe. You know.
Speaker 3: Our members find it disrespectful, you know, they really it's disheartening. Yeah, yeah, yeah,
Speaker 3: they just don't like it at all.
Speaker 2: Hence here we are with the forty eight hour strike, unprecedented,
Speaker 2: and our members are really unhappy about it.
Speaker 3: You know, they don't want to be doing that. They
Speaker 3: actually want to be inside working. That's what drives them.
Speaker 2: Ask anyone who is in a long term relationship with
Speaker 2: a doctor who is not also a doctor, and ask
Speaker 2: them what penalties that has put on their life together
Speaker 2: and on their family life if they have a family.
Speaker 2: It's a massive commitment, and medicine really eats people's lives up,
Speaker 2: you know, it's a huge thing. And I have so
Speaker 2: much respect for our members and the works they do.
Speaker 2: You know, the stories that I hear about the works
Speaker 2: they do, about the path they took to be able
Speaker 2: to do that work is incredible.
Speaker 3: But so much of the time now it's about well,
Speaker 3: I can't do that work. We should be doing this,
Speaker 3: we should be doing that, which should be doing this?
Speaker 3: Can't do it or it's dangerous. You know, our service
Speaker 3: is dangerous, and that's a terrible thing. People starting to
Speaker 3: decide didn't want to come to work today. You know,
Speaker 3: it's too hard, it's too risky. At the same time,
Speaker 3: trying to give patients confidence that everything's going to be fine.
Speaker 2: We're going to care for you. We will do our best,
Speaker 2: and they do, you know, but it's pretty grim.
Speaker 1: Thanks for joining us, Sarah.
Speaker 3: Thank you. It's been a pleasure.
Speaker 4: That said.
Speaker 1: For this episode of The Front Page. You can read
Speaker 1: more about today's stories and extensive news coverage and at
Speaker 1: Herald dot co dot nz. The Front Page is produced
Speaker 1: by Jane Yee and Richard Martin, who is also our editor.
Speaker 1: I'm Chelsea Daniels. Subscribe to The Front Page on iHeartRadio
Speaker 1: or wherever you get your podcasts, and tune in tomorrow
Speaker 1: for another look behind the headlines.