Investing in New Zealand S Future Health Workforce

Investing in New Zealand’s Future Health Workforce

Post-entry training of New Zealand’s future health workforce: Proposed investment approach

CONSULTATION SUBMISSIONS

Contents

TEC

Lakes District Health Board

West Coast DHB - Buller Community Mental Health

The Cancer Nurses College NZNO

Wairarapa DHB

Medical Council of New Zealand

Australian and New Zealand College of Anaesthetists

Whanganui District Health Board

Southern Institute of Technology (SIT), School of Nursing staff

Occupational Therapy Board of New Zealand, Osteopathic Council of New Zealand

School of Nursing, Faculty of Medical and Health Sciences, the University of Auckland

Waikato DHB, Nursing and Midwifery Directorate

NZ Association of Optometrists

Southern DHB, Allied Health

South Canterbury DHB

Midwifery Strategic Advisory Group

Psychotherapists Board of Aotearoa New Zealand

New Zealand Psychological Society

Clinical Advisory Pharmacists Association

Individual

New Zealand College of Public Health Medicine

New Zealand Medical Association

Council of Deans of Nursing and Midwifery (Australia & New Zealand)

Midwifery Council

Allied Health Directors in Mental Health and Addictions National Group

Eastern Institute of Technology, School of Nursing Advisory Committee

Centre for Postgraduate Nursing Studies, University of Otago

Allied Health Aotearoa New Zealand

Individual

Department of Psychological Medicine, University of Otago

New Zealand College of Midwives

Postgraduate Coordinators and Tertiary Providers’ Schools of Nursing Postgraduate Representatives

NZRDA

New Zealand Association of General Surgeons

Association of Professionals & Executive Employees

The Royal New Zealand College of General Practitioners

Te Pou o te Whakaaro Nui

The Royal Australasian College of Physicians

Universal College of Learning

Physiotherapy NZ

Tairāwhiti DHB

Australian and New Zealand Society of Geriatric Medicine

Family Planning New Zealand

New Zealand Blood Service

AUT, Faculty of Health and Environmental Sciences

Nurse Education in the Tertiary Sector (Aotearoa NZ) (NETS)

The Royal Australian and NZ College of Psychiatrists

Nursing Workforce Governance Group (taskforce)

Faculty of Health, Victoria University of Wellington

Association of Salaried Medical Specialists

Canterbury and West Coast Regional Directors of Nursing Group

New Zealand Public Service Association

Whanganui DHB

Plunket

New Zealand Nurses Organisation

Whitireia-WelTec Centre of Learning for Health & Social Services

College of Nurses Aotearoa (NZ) Inc

Council of Medical Colleges

South Island Alliance

New Zealand Branch of the Royal Australian and New Zealand College of Ophthalmologists

Comprehensive Care

The Royal New Zealand College of Urgent Care

Dietitians New Zealand

New Zealand Hospital Pharmacists' Association

Nursing Council of New Zealand

Auckland DHB, Radiation Therapy

New Zealand Society of Anaesthetists

Northern Region’s DHBs

Department of Nursing, Health Services, Hawke’s Bay District Health Board

Platform Charitable Trust

Executive Directors of Allied Health, Scientific and Technical for the Central Region

School of Medicine, University of Auckland

Clinical Leadership team, West Coast DHB

Royal College of Pathologists of Australasia

New Zealand College of Clinical Psychologists

People & Performance, Waikato District Health Board

Director of Nursing, Bay of Plenty District Health Board

Industrial & Employment Relations, Capital and Coast District Health Board

Royal Australasian College of Surgeons

Pharmaceutical Society of New Zealand

Pasifika Medical Association

Health Quality and Safety Commission

DHB Midwife Leaders

Graduate School of Nursing, Midwifery and Health at Victoria University of Wellington

Midland District Health Boards GMs Human Resources and Regional Director of Workforce Development

University of Canterbury

Toi Ohomai Institue of Technology, Department of Nursing

Eastern Institute of Technology,School of Nursing

Southern DHB, Nursing and Midwifery

Nurse Executives of New Zealand Inc.

School of Nursing, Massey University

Waitemata District Health Board

Nurse Practitioners New Zealand

Pharmacy Council

New Zealand College of Critical Care Nurses

New Zealand Orthopaedic Association

Executive Directors of Nursing and Midwifery, Capital & Cost DHB

Regional Director for Workforce Development Central Region

Submitter / Tim Fowler
Contact details /

TEC

RE: Investment Approach - consultation submission

Thanks for seeking TEC feedback on HWNZ’s proposed investment approach.

As you know, TEC and HWNZ are working together at an operational level to improve our shared understanding and use of data about the health workforce pipeline and training approaches. That work clearly holds a lot of value for both our agencies, and ultimately for the efficiency and effectiveness of the government spend in this area.

I note that the HWNZ consultation proposal is about optimising the way HWNZ spends its ~$180m of funding for post-entry training, working toward a transparent ROI methodology to support a fully contestable approach over time. The consultation document acknowledges the need to align this investment with other health workforce training funds, including TEC funding for provider-based training. We all want to make sure that TEC’s funding levers complement rather than undermine those of HWNZ, and that TEC doesn’t inadvertently invest in areas from which HWNZ has strategically divested.

Ideally, health providers and training providers would have to meet the same test of public value,basedon a robust assessment of the contribution to health outcomes –regardless of which agency or vote the money flows from. We can promote that by TEC and HWNZ working toward a shared framework for assessing the value of different kinds of spending on training the health workforce. It’s great that we’re already on the road to that goal via our cross-agency operational work, and I look forward to seeing it develop and mature.

Regards,

Tim Fowler

Submitter / Jenny Martelli
Contact details / Service Manager MMU and Hospital Support
PH: 07 343 7769
Cell: 027 2428013

Lakes District Health Board

Proposed Investment Approach to Post Entry Training of New Zealand’s Future Health Workforce

Thank you for the opportunity to comment on the proposed investment approach.

Firstly we are in agreement that the current funding model is in need of review and appears to be based on historical arrangements and funding models. It is inconsistent and has no apparent rhyme or reason.

Lakes DHB covers rural and provincial areas and suffers from the uneven distribution of skilled workforce. The current medical training programmes advantage the larger DHBs as most advanced training posts are in tertiary centres, which means the trainee is employed and living in a large city at a time in their life when they are finding life partners and starting their families. This then makes it more difficult for them to move to a provincial DHB to take up a consultant position as their family is settled and their partner often has a good job that they don’t want to leave.

We also find that the larger DHBs that have the advanced trainees offer them consultant positions before the end of their final training year and the provincial hospitals don’t get an opportunity to recruit these new consultants.

We would like to see a fairer distribution of trainees throughout the country with particular emphasis placed on not only hard to staff specialties but also on hard to staff DHBs. A trainee who experiences medicine in a rural or provincial setting is far more likely to pursue a future career in that area.

Process Model

It is agreed that the process needs to be commission led. Whilst we agree that a certain level of funding needs to be directed at the MOH strategic priority areas, the maintenance of basic medical training in all core medical specialties must not be compromised.

Funding Model

It is agreed that the Sliding Scale funding model would work best out of the three proposed.

Disinvestment process

We are curious to see how the funding in low priority areas will be reduced once current trainees finish their programmes as the funding is not necessarily tagged to a particular trainee but is allocated to the DHB provided you have a trainee in that position. Are you suggesting that going forward the funding received for a particular trainee in our employ will follow that trainee to whichever DHB they work in for the duration of their training?

As an example, if our DHB had a first year basic medicine trainee who was currently being funded by HWNZ and that trainee moved on to Waikato next year and was replaced by another first year basic medicine trainee we would not receive any funding for the replacement trainee but Waikato would receive funding for the second year trainee they got from us?

Could you please clarify what this sentence means, “Any reduction in HWNZ-funded trainee volumes will take into account employer’ contributions to training and long term sustainability?”

Investment Cycle

How often will HWNZ publish its strategic Intent/investment intentions? Is it intended to make the contestable investment approach an annual process?

Investment Period

If a DHB is successful in securing investment from one of their proposals could that investment money be made available to the DHB for multiple years or would that funding become contestable again the following year, requiring a further proposal?

DHBs rely on a certain level of consistency of funding to manage their resources effectively and the uncertainly of the level of HWNZ funding available each year will be problematic.

Once again thank you for the opportunity to comment.

Jenny Martelli

Service Manager, Medical Management Unit and Hospital Support

Lakes District Health Board

Submitter / Lorraine Tewi
Contact details / Pukenga Tiaki
Buller Community Mental Health
46 Cobden St
Westport
Ph: 03 788 9023 ext: 8713
Cell: 027 7036 722

West Coast DHB - Buller Community Mental Health

Kia ora,

The difficulties I foresee with this type of funding is that it may not align with the direction of learning required for Maori within Kawa and Tikanga practises, as I am already experiencing.

Nga mihi

Submitter / Judy Warren, on behalf of The Cancer Nurses College NZNO
Contact details / Felicity Drumm
Clinical Oncology Nurse Specialist
Regional Cancer & Blood Services
Auckland District Health Board
Ph: 307-4949 ext 23190 or 021 983 829

Cc:

The Cancer Nurses College NZNO

To Whom It May Concern

Re: Proposed new investment approach to Post-entry training of New Zealand’s future health workforce

Thank you for the opportunity to provide comment on the above document. The Cancer Nurses College NZNO advises as follows:-

We welcome the proposed adoption of a more strategic model of funding which recognises the rapidly changing models of care in which New Zealand’s nurses now find themselves working.

From an oncology perspective, clinical service demands have never been greater, or under such duress. Our cancer population is burgeoning, with a rapidly growing, ageing populace together with increasing and more complex treatment options, prolonged treatment periods and improved survivorship (Ministry of Health, 2013).

Nationally, regional Cancer & Blood services must embrace innovative models of care to ensure continued provision of sustainable safe and timely delivery of tumour stream pathways and faster cancer treatment goals, in a climate of fiscal constraint, medical oncologist scarcity, and limited operational and clinical resource (Ministry of Health, 2013).

in 2014, a Ministry led, Cancer Nursing knowledge and skills framework was developed, to guide the development of a flexible and sustainable cancer nursing workforce capable of providing high-quality services to meet the needs of New Zealand’s cancer population. Whilst this provides the framework for essential learning and skills, to date we lack the associated accessible and recognised educational programme in support of the frameworks desired nursing skill set and required knowledge standards.

If we are to provide a sustainable, high level and committed cancer nursing workforce, it is hoped that future HWNZ funding will support cancer nursing education programmes, which are adaptable for future proofing and inclusive of our learning needs across oncology from novice to expert.

Kind regards

Judy Warren

Cancer Nurses’ College NZNO

Submitter / Wairarapa DHB
Contact details / Bernadette Cloutman
EA to Chief Executive | Board Secretary
Wairarapa DHB
Phone +64 (06) 9469800 x 5100
Direct Dial +64 (06) 9469 858

Wairarapa DHB

Good afternoon Paul

Many thanks for the opportunity to feedback, Wairarapa DHB would like to input the following comment:

“The one thing I’d be keen to see is the inclusion of data analytics / informatics as part of the focus of workforce development. I am not thinking IT folk. I do believe that the future workforce will need to include a considerable skill base of clinical and business data analysts/scientists.”

Regards.

Bernadette

Bernadette Cloutman | EA to Chief Executive | Board Secretary

Wairarapa DHB

…………………………………………………………….………………

Phone +64 (06) 9469800 x 5100
Direct Dial +64 (06) 9469 858

Medical Council of New Zealand

26 April 2017

Dr Paul Watson
Manager Strategy and Policy
Health Workforce New Zealand
Ministry of Health

Via email only:

Dear Dr Watson

Health Workforce New Zealand consultation paper on funding for postgraduate training

The Medical Council of New Zealand (Council) appreciates the opportunity to provide feedback to HWNZ on its consultation paper. However before I provide substantive feedback, there are several procedural comments which I consider important to provide.

The most important procedural comment is that HWNZ’s paper is based on the assumption that the current funding model will not meet the future workforce need. However no evidence is provided to support this assumption, and no evidence is provided to show that the proposed solution would succeed. This means that Council’s substantive feedback is by necessity based on assumptions about what HWNZ understands is the problem and what changes are intended.

There are several statements in the paper that are presented as fact without evidence to support them. In particular:

‘… the current process does not have a standard approach to prioritising funding of training and is neither transparent nor rigorous’. This is under ‘The case for change’. However, it is for HWNZ and the Ministry of Health to review their own processes first so that they do prioritise funding, and so that it is transparent and rigorous. The consultation paper targets the Colleges, rather than considering if there are any steps that could be taken by HWNZ and DHBs internally to improve the approach to the funding of training in the first instance.
‘Investment in post-entry workforce planning is not currently able to be prioritised towards these strategic priorities (within the New Zealand Health Strategy) and does not incentivise innovation.’ The information in support of this statement is not provided so we are unable to assess what HWNZ perceives is the real issue here.
‘The investment approach will strengthen HWNZ’s sector intelligence related to unmet need, emerging technologies, and changing models of care.’ It is unclear how this would occur. In one sense the paper argues that funding needs to be contestable so that it can be prioritised into areas of unmet need (ie, identify the need through data etc and change funding into areas of unmet need – which has logic), and yet here the argument is the opposite – that the investment approach will improve HWNZ’s knowledge.

The idea of contestability of funding is balanced to some degree by principles such as ‘A sustainable supply of non-prioritised vocational training specialities is assured’, and ‘Implementation is transitioned over a period of three to five years and ensures manageability of change impact.’ However contestability would create risk to the current numbers of doctors in training in different scopes of practice, and Colleges will be justifiably anxious about the impact on them. There is insufficient detail in the paper to make a valid assessment and it is therefore impossible to reach meaningful conclusions. For example, what proportion of the funding is contestable? If HWNZ’s predictions about the future workforce needs are inaccurate and a training provider has lost funding and capability, how is this restored?

A second procedural comment is that the Chair of HWNZ has made public his belief that these ‘proposed’ changes to funding processes will be implemented. This undermines the intent of a genuine and open consultation process.

Regarding Council’s substantive feedback, it is important to remind HWNZ of Council’s statutory purpose; ie, to protect the health and safety of the public by ensuring doctors are competent and fit to practise. Our functions include ‘to prescribe the qualifications required for scopes of practice within the profession, and, for that purpose, to accredit and monitor educational institutions and degrees, courses of studies, or programmes’.

Prescribing the qualifications for practice and accrediting the education and training organisations that grant those qualifications is critical to ensuring doctors are competent and fit to practise at the time they are registered in their particular scope of practice. This includes graduates of Australasian and New Zealand Colleges. Council’s role is very much about setting standards for practice in New Zealand, promoting those standards and enforcing them as necessary.

The consultation document does not make any reference to accreditation standards and processes, and how it anticipates that contestable funding cycles and accreditation cycles would be linked. It seems to suggest that investment should drive quality, rather than quality driving investment and funding decisions.

Any changes to the funding scheme are likely to have implications for Colleges being able to apply for and maintain accreditation as a training provider. This would then also have a potential consequences for the mutual recognition of postgraduate medical qualifications across New Zealand and Australia. It is essential to maintain and continually improve the quality of training programmes. In addition, the competitive approach being proposed is likely to favour the larger Colleges that have the resources and infrastructure to develop and submit funding proposals, compared to smaller Colleges which may not have this level of capability or capacity.