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The human cost of centralising our health system

There is to be a radical change in the way health services are delivered in New Zealand.

Health reform announcementAll 20 district health boards in New Zealand are to be abolished and replaced by a single national organisation called Health New Zealand. Health New Zealand will have four regional divisions.

A new Māori Health Authority will be established with the power to commission health services, monitor the state of Māori health and develop policy.

A further new Public Health Authority will be created. The Ministry of Health will be strengthened and will monitor performance and advise the Government.

Essentially, we are moving from a decentralised model to a very centralised one. This ought to allow for the right amount of specialisation for New Zealand and better access to healthcare, especially from the regions that are not well serviced now.

Reference is made to early intervention to keep people out of hospitals. Reference is made to our ageing population and the need to respond to health crises like the Covid-19 pandemic.

Time will tell whether these changes make much difference to the way the public is cared for.

Māori health statistics show there is real need for a more focused healthcare for Māori. The creation of a new Māori Health Authority is a positive change for the better in the new structure.

Overall, two things are certain.

Firstly, the change will cost a very large amount of money.

Secondly, there will be significant employment consequences. It seems safe to assume that the leadership and support structure in the 20 district health boards will be stripped out. People will lose their jobs. Most should be re-employed in the four regional centres or one of the new national organisations such as Health New Zealand, but many will obviously miss out.

It will be interesting to see whether those currently employed will be given preference over new people when the new bodies are looking for staff. The usual employment law would mean the new bodies, as different employers to the health boards, would not be obliged to take on existing staff. No doubt the relevant unions will be knocking on the minister’s door, asking for assurances for their members.

Further, the shrinking pool of employers for medical professionals would significantly increase the impact of a serious misconduct process involving a doctor, for example.

Many of these processes end in an agreed departure, including confidentiality terms. These enable the parties to move on without litigation to decide the merits of the allegations and dismissal.

A doctor might move from one health board to another, confident that the former employer cannot disclose what was alleged. With a centralised employer, many medical professionals will have fewer alternatives. They might want to move to another hospital, but it’s more likely to be the same employer.

A similar problem is arising for career public servants in general. The Public Service Commission recently released new guidelines for recruitment practices. The new policy applies to many governmental organisations.

The new guidelines suggest recruiting bodies ask applicants whether they have been subject to a serious misconduct investigation. Where that investigation is concluded, and the finding of serious misconduct was upheld, the prospective employer wants to know about it. Similarly, where the investigation is current and not yet concluded, the government employer wants to know about that too.

At the application stage, a prospective employee is asked to consent to a serious misconduct disclosure from their previous employer. If they do not consent to a serious misconduct disclosure, this does not mean they cannot be employed.

Obviously they will be asked why they refused to consent and that will be considered in deciding whether to progress the application. But realistically it is not easy to believe that such a person is likely to be employed.

Employing managers are asked to decide on a case-by-case basis including looking at the risk profile of the role and the requirements of the position. How recent any integrity or conduct issue occurred is a consideration. So is any counselling, retraining or rehabilitation the person has undergone. Finally, the explanation by the candidate is also relevant. Generally, the inquiry goes back only three years, but for senior or high-risk roles the inquiry may go back further.

To aid with this approach, the commission has suggested that government employers think carefully whether to include confidentiality terms when settling matters. They are encouraged to consider in settlement discussions what the parties can agree to say if consent is sought for disclosure further down the track.

Many candidates will be surprised to hear about these new guidelines and the impact they have on their privacy. People want the opportunity to put their mistakes behind them and move on with their lives.

The new guidelines suggest recruiting bodies ask applicants whether they have been subject to a serious misconduct investigation. Where that investigation is concluded, and the finding of serious misconduct was upheld, the prospective employer wants to know about it. Similarly, where the investigation is current and not yet concluded, the government employer wants to know about that too.

At the application stage, a prospective employee is asked to consent to a serious misconduct disclosure from their previous employer. If they do not consent to a serious misconduct disclosure, this does not mean they cannot be employed.

Obviously they will be asked why they refused to consent and that will be considered in deciding whether to progress the application. But realistically it is not easy to believe that such a person is likely to be employed.

Employing managers are asked to decide on a case-by-case basis including looking at the risk profile of the role and the requirements of the position. How recent any integrity or conduct issue occurred is a consideration. So is any counselling, retraining or rehabilitation the person has undergone. Finally, the explanation by the candidate is also relevant. Generally, the inquiry goes back only three years, but for senior or high-risk roles the inquiry may go back further.

To aid with this approach, the commission has suggested that government employers think carefully whether to include confidentiality terms when settling matters. They are encouraged to consider in settlement discussions what the parties can agree to say if consent is sought for disclosure further down the track.

Many candidates will be surprised to hear about these new guidelines and the impact they have on their privacy. People want the opportunity to put their mistakes behind them and move on with their lives.