25 / 09 / 08 - In a surprise decision announced today, the Court of Appeal quashed last year's High Court ruling that the decision of the Auckland Regional District Health Boards to hand the contract to Lab Tests Auckland ahead of Diagnostic Medlab Ltd (DML) was invalid
------------
22 / 09 / 08 - Southern Cross Healthcare is urging the Auckland, Counties Manukau and Waitemata DHBs to reassure Aucklanders that they can have faith in the consultation process. "Consultation implies views will be listened to. That has certainly not been the case in other parts of the country where widespread opposition to charges for laboratory tests has been largely ignored. Should the Auckland Boards be so cavalier it would make a mockery of the consultation process and Aucklanders should rightly demand a reassurance that this isn’t just the Boards going through the motions on a pre-determined decision." Auckland-area residents can register their views on the lab testing consultation here.
------------
09 / 05 / 08 - In Appeals Court today, the Auckland DHBs criticised former Lab Tests Auckland director Tony Bierre for not adequately disclosing the extent of his conflict of interest after his 2004 election to Auckland DHB – an ironic development, since it was the ARDHBs who gave the contract to a lab which they were well aware was owned by one of their own members.
------------
05 / 05 / 08 - Australian-owned Lab Tests Auckland went to the Court of Appeal in Wellington today in its bid to win back its $560 million contract for Auckland's pathology services. Check back here for updates as the appeal progresses.
------------
18 / 04 / 08 - The Health Funds Association of NZ has released their findings on the practice now adopted by several DHBs of forcing patients to cover the cost of lab tests ordered by specialists, saying that:
"... putting the burden of lab testing costs on patients has increased total health costs for New Zealanders, with little direct saving for the DHBs concerned, and is an exercise in ideology rather than sound health policy
."
------------
19 / 12 / 07 - Healthscope, in its continuing bid to become the dominant pathology provider in New Zealand, announced yesterday it had acquired 100 per cent of the shares in NZ Diagnostics Group (mostly trading under the brand name Southern Community Laboratories [SCL]), making it the second largest private pathology group in the country behind Diagnostic Medlab.
"In April the DHBs set up an Independent services support agency to (among other duties) monitor the interim contract, and research the community-pathology tendering and contracting process. The committee's initial research on the magnitude of work involved suggests Labtests' projected savings were untenable – and the agency has recommended labs should be ready to open before they tender."
"We had expected that, if anything, the Auckland DHB might have a higher sensitivity to conflicts of interests, because of the previous conflict-of-interest concerns. At the Auckland DHB it was not apparent to us that the board made any significant attempt to engage with conflict-of-interest issues."
------------
31 / 10 / 07 - Health Minister Pete Hodgson, after less than two years in the job, has been replaced today by David Cunliffe, and Association of Salaried Medical Specialists President Jeff Brown says of the appointment:
"I hope it may change the atmosphere and help create a reconnection between himself, doctors and the DHBs."
------------
15 / 10 / 07 - Three-quarters of DHB members were re-elected in local body elections at the weekend, but new members, including many health professionals, say it is time to address significant problems:
"One of three doctors elected to Wellington's Capital and Coast DHB, Peter Roberts, says managers have had too much control at the expense of others, such as those who deliver care. David Tranter, of Democrats for Social Credit, regained a seat on West Coast DHB and says board members everywhere should be asking questions.
"
------------
04 / 10 / 07 - The Royal College of Pathologists in Australasia has issued a Crisis Warning for Pathology in New Zealand and Australia, saying:
"The move to open community laboratory testing for tender is contributing to a crisis in pathology services, says the RCPA, whose figures show the number of pathologists – laboratory doctors who diagnose 70 percent of all diseases – has dropped by 7 percent over the past five years, while the population has increased by 5 percent
."
------------
04 / 09 / 07 - : Lab Tests Auckland's appeal of Judge Asher's decision negating the Auckland contract has been scheduled for May 2008. See the "News" page for more details.
------------
17 / 04 / 07 - Lab Tests Auckland have
this afternoon announced
they will
appeal the judicial review. It is understood the ARDHBs will not be
joining their appeal. More details coming soon, but for now read this from
the article:
"Mr Dixon said Dr Bierre had recently decided to
resign as chief executive and company director to pursue other opportunities."
------------
14 / 04 / 07 - Bronwyn
Howell from NZCPD
discusses the governance issues brought to light by Justice Asher's verdict,
and clearly explains how the existing DHB and PHO structures created an
environment that allowed a fiasco like Labgate to happen. The below
quote shows why it is necessary for at least Wayne Brown and Ross Keenan to be
sacked, if not the entire board:
"The farmer [Minister]
sets the rules that govern the henhouse before handing it over to the foxes
[DHB Board Members]. When he discovers mayhem in the henhouse, he shoots the
fox that broke the shackles, and shoots the other foxes because they failed to
either stop her or alert him. For if they had stopped her or alerted him in the
first place, there would be no mayhem to discover. But if the farmer fails to
shoot any of the foxes, they can cause mayhem again. Foxes learn fast that
the farmer won’t shoot even when they break the rules. This knowledge
assists them in their choices when they guard the sheep as well as the hens.
"
If they aren't sacked then we can
expect this sort of debacle to happen again. It could go unreported next
time and patients may suffer. This is not acceptable. The current
structure also has inherent design flaws and needs to be reviewed.
------------
09 / 04 / 07 - It's all a little too late for Wayne Brown as he
attempts a charm offensive via the
Sunday Herald. It's amazing how the arrogance and tough guy talk are
gone, and now we're told "He's interested in improving health for
disadvantaged and powerless people. And in doing things right: less waste, more
health." Where's the taxi comment now?
Where has the "doctors are like rabbits managing the lettuce patch" attitude
gone?
Here is a man who wanted to destroy the
Starship brand to save
the ADHB money, because in spite being New Zealand's most valuable charity
brand, donating millions to healthcare in Auckland,
Brown decided that it didn't suit the ADHB budget to have non-locals driving
to the Auckland CBD to have their children seen because it was a brand they knew
and trusted. Hey CMDHB and Waitemata....not on my budget mate!
Cost shifting is not an art or a science, it's an accounting fiction, and any
belligerent bureaucrat can do it. Deferring maintenance, reducing scope,
cutting, chopping, and simply slashing might look good on today's balance sheet,
but long term it's a damaging and expensive strategy which does no one any good.
It would be fascinating to read an independent study into the decisions he has
made in his previous appointments and the long term down stream effect of those
decisions.
To
claim this whole labgate fiasco has been a success is truly audacious spin and
nothing more than a desperate attempt to justify his continuing employment.
"It's a wonderful story of
success," he told me over a briskly eaten lunch. "The lab test fiasco, if there
has been one, has been the withdrawal of [the] labour of people doing the tests.
If our politicians - the ones picking on me, who've become obsessed with this -
if they cared about health they'd get into that. No person in Auckland is going
to miss a community lab test and no person would have."
No
one withdrew their labour Wayne, they simply didn't want contracts with the new
provider. You're a big fan of the free market, I'd expect you of all
people to respect an individuals choice not to work for a company. If you
or the board had bothered to do proper due diligence you would have known that
the new company was unlikely to be able to attract the required talent from the
local region. Treating the pathology staff of Auckland like chattels was
an arrogant mistake still awaiting an apology.
Wayne is undoubtedly a successful businessman. Outside the board room he
is probably a good father and may even be a nice guy. However, his
monomaniacal focus on dollars lacks sense and humanity. He has no place in
healthcare and should be moved on to an industry that is not focused around
people. There his style would achieve a much better result.
------------
04 / 04 / 07 - Some people just
don't know when to admit they got it wrong and accept the referee's decision.
Read Wayne Brown's latest. I'm completely gobsmacked. He is virtually
saying there will be an appeal......
"They [DML] managed to link
a former board member [Bierre] in as a conflict, when I can assure readers his
involvement meant nothing to the boards...."
"...but things do go wrong
in the justice system. That is why we have courts of appeal."
"Don't believe all you read
in the national papers, trust your local"
------------
29 / 03 / 07 - So a second blog today
but so much has happened. First news, the forum will go offline
shortly, leave your parting message asap! Secondly, the ARDHBs
have given DML an interim 18 month contract so the tender process can
be run again and we can repeat the process of awarding a contract to a
long term supplier.
A few issues:
After all the who ha,
is anyone remotely connected to this whole fiasco actually surprised
at the outcome? Ok it took a judge to do it, but awarding an
interim contract solely to DML was surely the only feasible option
from day one. Lab Tests Auckland were surely never going to be able to
recruit the required talent.
Healthscope and
Lab Tests Auckland apparently both told Loreli Mason of TV1 that they weren't
able to provide an interim service. Well duh, isn't that what
the evidence has been saying for months? Recruitment issues
anyone?
Tony surely can't
last long. His shareholding is worth nothing now and
Healthscope would surely buy him out for a dollar. Time to
replace Tony and bid again? They have lost all credibility.
It's history burger for Healthscope and I can't see them hanging
around for 18 months to win this contract again.
Wayne has now
apologised for misleading Pete Hodgson. It's time for him to
catch a taxi to Piha and enjoy surfing for a while. Surely he
will not survive this fiasco.
Ross, Wayne and Garry
have to go. They have been chief apologists for this fiasco
and appear to have been drunk on Tony's sweet savings. They
cannot fairly judge any future tender and must be put out to
pasture. Taxi's anyone?
The saddest thing about
this whole fiasco is that I do believe they had Auckland's best
interests at heart. Saving money on health services is a good
thing and arguably they have done a good job of that over the last
while.
Ultimately their
monomaniacal focus on saving money got the better of their common
sense, and they awarded the contract for lab testing to someone who
should not have been involved in the tender at all.
Diagnostic Medlab
evidently provide a superb quality service for a reasonable price.
Their contractual incentives are to decrease the amount of testing, or
at least maintain it. In my time campaigning I have come to know
many of the DML staff on a professional level and they do not
encourage wastage.
They are conscious of
their position as a taxpayer funded service, and for a monopoly
organisation they are very customer focused. This is testament
to their ethics and professionalism.
Auckland is lucky to
have a company like DML, with a culture such as theirs, providing us
with the service they do. Thank goodness that will not change
for the next 18 months.
Hopefully they can
convince the bureaucrats of their value so they can continue servicing
our region.
Congratulations DML.
Best wishes to all the staff. It has been a long hard struggle
but common sense and fairness have won for now. Just make sure
you deliver what's required in future so we can continue our
relationship in future.
ps. this website will
stay live but the forum will go offline shortly. Links will be
updated but my blogging will be more infrequent. Of course, if
the ARDHBs make another poor decision about the community lab contract
I'll get up and cranking again. We need a top quality lab
service. It saves us money and improves our quality of life!
------------
29 / 03 / 07 - Short blog today - where has the Lab Tests Auckland
website gone and what about their job ads? I thought they were
committed 100% and expected their recruitment would continue.
What does this mean. Stay tuned for further developments.
------------
25 / 03 / 07 - Well by now everyone
should know the judgment, and we're all keenly awaiting the outcome of
the negotiations for an interim contract to maintain community
laboratory services from July 1.
Rather than dissect or
dwell on the verdict, of which there are hundreds of media articles,
I'd rather contemplate the future, of which there are many questions.
Consider this:
Given Justice Asher's
verdict, is it right that a company whose CEO is found to have a
conflict of interest should be considered for an interim DHB
contract?
Given their
inadequate handling of the original tender, is it acceptable that
Wayne Brown or Ross Keenan be involved to secure an interim
agreement?
If Lab Tests Auckland are
gearing up a lab to process 30,000 samples a day, how could they
survive financially for 6,12 or 18 months while a new tender process
is completed.
How could they offer
to do 10% or even 20% of the work at the same price as DML who
would have the economy of scale. Can they wear losses for that
long?
Then consider that
elections are not far away, and surely Labour cannot afford to support
Keenan, Brown or Smith for long.
I feel now that the
Lab Tests Auckland brand is tarnished beyond repair. I cannot foresee how
the DHBs could ever justify awarding them any kind of contract.
How could we have confidence in any service they were to provide.
Who do you want your
tax dollars funding, and who would you want your
sample taken by?
------------
15 / 03 / 07 -
You have to wonder how anyone could have let Wayne Brown loose on
humans and a public health system when he makes comments like this in
a Herald article today
"Hospital
'like a big factory' for elective surgery results":
When commenting about a
backlog of 12 weeks for radiotherapy, Wayne is quoted:
"Mr Brown said wait
times had grown due to industrial action and "above average turnover"
of staff before Christmas.
"Workforce is the biggest limiting factor in this particular issue.""
Wayne, I don't know,
but do you think that might have something to do with the way
you handle human resource issues? Funnily enough people aren't rushing
to work for someone who says things like this:
"We've brought very
much a production-orientated approach to the running of the hospital.
Making it like a big factory as much as we could. We've tried to
remove the emotion, just run it as a productive unit,"
And before I almost
fell off my perch in fits of laughter, I read this!
"He told the Herald
later that while there were extended wait times for cancer patients,
the hospital was ahead of targets in some areas, such as hip surgery.
"We're so far ahead, we're having trouble finding people to get them
done.""
Geeze Wayne, was
it you or your friend Garry who said that the savings from the new
community laboratory contract were necessary so that money could be
spent on badly needed hip operations that....you can't find anyone to
give?!
I'm almost
dumbfounded.
Oh and as usual Pete
Hodgson made a ridiculously out of touch comment, suggesting that
waiting 12 weeks instead of 4 for radiotherapy actually resulted in
some benefit for the patient, despite his own ministry's
guidelines stating 4 weeks is the maximum. He said:
"Mr Hodgson said
while the guidelines were on the website, the ministry and the
oncology community had "long held the view that waiting up to 12 weeks
has little or no effect on the cancer outcomes" - a notion disputed by
some oncologists.
"Indeed, [the waits] are suggested in some cases to be of value to
patients because they need to prepare for the radiotherapy," he said."
If Pete got prostate
cancer do you think he'd wait 12 weeks to start treatment because he
needs good time to prepare himself?
He's spun that so badly
I almost feel giddy, especially considering someone I know has just
been diagnosed with prostate cancer and is carefully considering their
treatment options.
I asked him the other
day how it felt walking round knowing he had prostate cancer.
His reply was that he couldn't really relax and just wanted to do
something about it as fast as possible. The inaction while
waiting for assessments and consultations was driving him round the
bend.
Thanks Pete and Wayne.
Thanks a bunch.
------------
14 / 03 / 07- While we wait for a
verdict most of the discussion on the forum has been about Labtest's
progress to date, or more to the point, lack of public announcement of
that progress, if in fact there is any.
Lab Tests Auckland have recently
overhauled their website, and with that "upgrade" has been the removal
of many things, including their previously published timeline for
recruitment. Some of the more important details they no longer
have available have been linked or republished below for your
information:
Recommended reading is the announcement
about the computer system. Cute photo, what's missing is the
data. I don't so much care about a fancy looking computer as I
do about whether my personal records will be available on it to my
GP for diagnostic purposes. We have yet to hear an
announcement about that.
Finally, if the January 2007 was due to
be the completion of the senior level recruitment, why has there
been no announcement about the completion of a successful
recruitment drive? In a recent press release LTA said that
pathologists had been hired. They just neglected to mention
how many, and who. Rather important details don't you think?
------------
28 / 02 / 07- So while we hurry up
and wait for a verdict most of the action has been in the forums,
hence my lack of recent blogging. One concern that has come to
my attention again is the basic lack of understanding that the Health
Minister, Pete Hodgson, has about this issue. He still
doesn't have his "bits of data" in order, and this was recorded in
parliament yesterday in response to a question from Tony Ryall when
speaking about productivity in the health sector:
"An example of this
is the $15 million per annum laboratory contract that the three
district health boards have undertaken-a saving of $15 million per
annum, prospectively-opposed, almost unbelievably, by the National
Party."
A few facts for the
minister:
It's a $560m contract
over 8 years, not a $15m contract
The savings weren't
$15m/year against the opposing tender, they were about $8m/year.
The oft quoted $15m saving is a load of tripe spouted by the ARDHBs
comparing the new contract to the old one - hardly relevant
The National Party
like the Green Party, have prospectively opposed this contract
not unbelievably, but most understandably given the
uncertainties surrounding continuity of service provision and
maintenance of service levels.
Ross Keenan (ARDHBs) - Nothing can be guaranteed—I would be
foolish, we would be foolish....Any large contract has risk—that’s
life."
Pete Hodgson needs to
be taken to task on this issue. Either he's woefully misinformed
or completely oblivious to reality.
Get your act
together and get your facts straight Pete!
------------
20 / 02 / 07 - Revealing quotes from today's court
session as quoted on
NZ Doctor:
"He
[Mr Illingworth - counsel for ARDHBs] said a 50 per cent weighting
for “value for money” in the tender discussion document showed DHBs
were above all looking for cost savings.
Mr Illingworth described this as “the big red button, the one that
really mattered” and continued, “Who pushed that button? Labtests. Why
did they get the contract? Because they pushed that button.”"
It's taken 7 months to
get to the truth, and finally it was admitted by the ARDHB's council
in court to a judge. What a surprise. It was all about the
money. It has always been about the money. We all knew
that, they finally admitted it. Those comments make a farce of
Garry Smith's NZ Herald article:
Lab service change not all about the money.
------------
19 / 02 / 07 - Three classic quotes
from today's rebuttal by Mr Illingworth, representing the ARDHBs,
recorded by NZDoctor:
"These services need
not be outstanding, but rather the best affordable services available."
“They weigh up the
risks and work out whether the potential health risks are worth the
gains,” Mr Illingworth said.
“Tony Bierre knew a
huge amount from his MBA papers and his experience as a pathologist,”
Mr Illingworth stated.
Based on previous
evidence presented, I'd say yeah right to at least one of those
statements. As far as the two other statements go, I ask you
this:
To make statement one
surely they are implying that under the new contract the service
levels have changed - in which case extensive consultation is
required which was clearly lacking. They shot themselves in
the foot with that comment.
Secondly, why
shouldn't our health services be outstanding? (cheers KRH) If
we already have an outstanding service why destroy it and rebuild?
How lucky would we be if the rest of our health services measured up
to the laboratory service we enjoy: private, efficient, dedicated
and staffed by experienced professionals without excessive
management. From a tax payers perspective it's a dream come
true.
Is the risk of
setting up an entirely new laboratory service from scratch in a year
and alienating a highly skilled dedicated workforce in worldwide
shortage worth a *potential* saving of 10%?
Just to repeat that,
you have the choice of tried and true, high quality service run out of
a $50m purpose built laboratory, or for just 10% less you can try a
paper plan with a one year timeframe, no lab, no staff, and an 18
month escape clause, to be run out of a rented warehouse.
They claim to have
weighed up the risks and worked out that the health gains are worth
it. Tui to that.
------------
18 / 02 / 07 - The measure of Wayne
Brown's thinking is summed up in his latest Sunday Star Times column:
"Fortunately, some
government boards have been adopting hard-nosed procurement policies,
insisting on excellent quality at the lowest possible prices and
acting to shake up comfortable long-term suppliers. The howls of
protest from those losing fat contract are being heard far and wide,
often dressed up in supposed concerns for public safety or any
equivalent headline-grabbing exercise. The media would do well
to warn the public to look behind such claims of care for public
wellbeing, to see exactly what personal benefits have been lost by
these recently shaken suppliers.
More power to those
putting pressure on suppliers! We will all get more roads and
more health services at no extra cost if our government organisations
start behaving like the big telcos who grind their suppliers costs
down to keep costs in check."
Two points, looking
behind such "hard nosed procurement policies" at the awarding
of these contracts reveals there is often far more to the
procurement decision than simply "excellent quality at the lowest
possible prices". Sustainability of service for one does not
appear to be a criteria for decision making, if Ross Keenan's comments
at the select committee are anything to go by.
Second point, health is
not communications. When suppliers fail people die. It's
not like
GDC Communications who got chiseled and eventually succumbed.
In that case while I was an IT subcontractor to them many people
didn't get the phone system they had ordered the first time, and I had
to wait more than 3 months to get paid. I got fed up with
turning up to do the IT part of the job only to find the entire PABX
wasn't set up, so refused further work from them.
In health continuity of
service is paramount. Wayne Brown would do well to learn from
the likes of McDonalds and Toyota who view their suppliers as part of
the family and work with them to ensure continuity of supply.
The current style of procurement appears confrontational and
combative, not an approach conducive to stable long term
relationships.
------------
16 / 02 / 07 - Today it was Harbour
PHO's turn, as leaders of the intervention, to present their case to
Justice Asher. You can read the NZDoctor summary
here. My understanding of their argument is that the new
contract is a significant change from the status quo and that they
should have been extensively consulted before the tender process.
They claim they weren't, so they want the decision set aside.
I have always felt the
ARDHBs were being quite disingenuous saying there would be not
substantial change to the status quo. The outcry since the
decision was announced is proof enough of this. If we were going to
continue with the same level of service GPs wouldn't be concerned,
would they?
If they had consulted
GPs about point of care collection they would have realised that many
of those who can already are, and for others there is
no substantial capacity for additional point of care collection.
DML have said they have collection centers because the economy of
scale makes it cheaper.
My common sense meter
tells me if it was cheaper to get GPs to do it, DML would probably be
paying more of them to do it, like any good efficient company.
Their parent company in Australia would demand it.
If so, how realistic is
that? If it's not realistic, then how long before Labtests "commits
suicide" and the ARDHBs take it over, only to force GPs to do free
point of care collection. Well, free to the ARDHBs. They
would probably charge the patients.
How great would
that be for health outcomes? Only those who can afford testing
shall receive it.
------------
14 / 02 / 07 - Well there was plenty
of dynamite in court today. How's this for a quote from the
court case today: " Mr Hodder cites a private email written
by Labtests’ director Tony Bierre saying, “What the DHBs are really
looking for is a provider that will commit suicide.” "
"When ADHB chair
Wayne Brown found out in July 2005, he asked Dr Bierre to be excluded
from the regional laboratories project.
Dr Bierre responded he thought everyone knew about his directorship.
He carried on participating in discussions until December 2005, when
board members realised he would be bidding for the regional contract
and told him to take leave."
I don't think I need to
add too much commentary around those allegations, other than to say
that Dr Bierre must have been in a very unique position to tender for
a public contract.
What is more worrying
is that it would seem the ARDHBs might have had second agenda,
deliberately setting out to contract to an unsustainable provider so
that they could later step in and take it over. If so, this is a
deeply cynical move and surely should have been the subject of
extensive public consultation first.
------------
12 / 02 / 07
-
Day one down and the best wrap of the day in court can be found
here at NZDoctor. Other items are linked in the
News section. I wasn't in
court, neither was Dr Bierre by the sounds of things.
The timeline for the court case is for DML to present their case,
followed by Harbour PHO, the ARDHBs and finally
Labtests Auckland. The court case will take two weeks
and the decision is expected by the 5th of March.
Mike stimulated a good debate on the forum today, I'd like to respond
to a few of the issues he raised:
The ARDHB's will not save $560m
over the next 8 years, that is the total value of the new contract.
The commonly quoted figure of $15m/year
or $120m over the term refers to the difference between the current
contract and the new contract. Both DML and Labtests' bids were below current spend.
The actual difference between DML and Labtests' new tender price is understood to be about $7m per year, or
about $56m over the new contract term.
It is understood that DML's expected
return was approximately 5% on their new tendered price.
Labtest's are reported to have set a 12.8% return in the North and
South article, though according to the
Healthscope website, they are expecting a 15-20% return over the
8 year term. I don't know which of these figures is the real
expected return, however doing a little maths:
Labtests' operating budget = $476-488m
or $60m/year
DML's tender was around $7m more per year than
Labtests
DMLs $616m budget @ 5% = $30.8m profit
DMLs operating budget = $585.2m or
$73.2m/year
Based on the above Labtests operating budget will be approximately $13.2m a year less, equating to about an 18% budget cut. So the question you have to ask is, can Labtests deliver the same quality of service on a budget that is 18% lower than one of the most efficient labs in the Sonic Healthcare group?
Given environmental factors such as a labour shortage, one would think that an 18% cost reduction is not
feasible unless costs are shifted or services reduced. Dr Bierre will tell you that money is wastage. I disagree. Certainly a portion of that money might be additional expenses
which could be shaved, but there will also be a significant
portion which is services, the services we now enjoy.
I have attempted to
get information from Labtests and the ARDHBs about the progress of
their start up, however little has been forthcoming. In
ARDHB meetings the lab contract discussions have largely been
confidential, so are not carried in the minutes. Labtests
press releases contain little substantive information about
recruitment numbers, rental of premises other than their
warehouse, and there have been no details about the locations of
new collection facilities or announcements about how they will
make up for the shortfall when the numbers are reduced.
The details are scant. The lack of transparency is scary.
This is not just "a
commercial tender", this is a public health contract tender,
the winner of whom will play a pivotal role in the success of
primary healthcare. Diagnostic medicine, or pathology,
underpins all modern medicine. The process of collection,
analysis and reporting of medical tests is of vital importance to
many people in the community. Diagnostic Medlab has honed
it's systems over many years to offer a service which closely
aligns with the needs of GPs and patients. Any change to
this system should include extensive public consultation and
rigorous due diligence to prove its benefits. Testing really
is the stitch in time that saves nine. Any break down in
this process will result in increased hospital admissions, placing
additional strain on an already struggling system, and any savings
will be quickly lost. Just a few of patients in ICU for a
couple of weeks could because of missed diagnoses or failure to
test, could make those "savings" disappear.
------------
11 / 02 / 07 -
We sit on the eve of a landmark court case which I predict will define
the future of privately provisioned community pathology in New
Zealand. Whilst that might sound a bit dramatic, consider the
following -
If Diagnostic Medlab win:
We're back to square one and the tender
process starts again.
The price will likely be paid in
resignations by at least, but not limited to, Garry Smith and Ross
Keenan who have been chief architects and apologists for this
affair.
Wayne Brown and Pete Hodgson are other
less likely casualties.
The re-election of health board members
is in the balance. Future elected board members will carefully
note the political fall out from supporting such a cost cutting and
workforce destabilising exercise. If we don't punish them at
the polling booth they'll keep allowing this sort of short sighted
lunacy.
Labtests will likely fold. Thin
profits evaporate fast and I cannot imagine Healthscope bankrolling
a lengthy appeal, or funding a venture without income for an
extended period.
As damage control the government will
announce a process to develop a comprehensive national strategy.
If Labtests and the ARDHB's win:
We will likely witness an exodus of
passionate pathology professionals from the Auckland private sector.
I have talked to many of these pathologists and technicians, they're
serious. To them this issue is a matter of principle and
ethics, not money.
Community pathology will become a
"Toyota lean thinking" commodity staffed by an increasingly imported
workforce.
Kiwis considering a career in Pathology
will revisit that decision.
New Zealand will continue down this
track of ad hoc DHB contract renewal and there will be no collective
strategy.
We will feel the full effects of this
decision over the next 10 years.
In other news, you have to chuckle at Wayne Brown, Dr Bierre and the
ARDHB's for refusing to front for
tonight's One News article by Lorelei Mason. The inevitable
result was a rerun of the famous Wayne Brown quip "They can either
work for the new company or...drive a taxi." Wayne will struggle
to top that one liner.
Why wouldn't Dr Bierre confirm how many pathologists were currently
contracted to Labtests?
Spin he fed to Lorelei like "he's [Bierre] very confident he'll
have the numbers to be up and running by July, he says he's in the
midst of recruitment and very satisfied with the response, especially
from pathologists," is now so hackneyed I don't think anyone believes
him.
The North and South article was impressive. Like the Herald,
TVNZ and the NBR they too have the measure of this issue and don't
suffer fools. I am sure the judge won't either.
Quotable quotes from the article:
"Other
concerns began to emerge. Like the acknowledgement by the
Auckland District Health Board that it knows of no laboratory anywhere
in the world that has processed such large volumes from day one."
"I'm
not nervous. I'm sleeping well," - Dr Bierre smiles.
"Employment
Relations Authority member Rosemary Monaghan said Bierre had made
destructive accusations against a colleague, had been disingenuous and
had made constant complaints about the resources available to him.
It appeared to be impossible to satisfy him....I would say he was not
preparef to listen to other points of view with any great degree of
open mindedness."
"Extensive
contact between Bierre and the ADHB over the future delivery of
pathology services is alleged between 2004 and 2005 and is largely
admitted."
Susuan Turner, CEO of Harbour PHO "We've been asking the DHBs about
their risk management but they defer and say it's not their
responsibility: Labtests has the contract so they just have to
deliver. But that doesn't give us any comfort. What will
happen if they don't deliver?"
"Unlike
DML's eight year contract, Labtests' rolling 18-month contract means
no guarantee of continuity for doctors and patients, and a tough sell
when it comes to convincing desperately needed foreign pathologists to
transfer their families to New Zealand."
There are many more gems but you get the gist. Buy a copy of the
latest North and South for the full story. Go DML, we're all
with you.
------------
10 / 02 / 07
- We're now nearing the middle of February and as previously mentioned
LTA's
published schedule said that in January senior recruitment would
be at the stage of "Contract,
offer and commitment."
So with no announcement's about successful appointments what can we
infer from this
this major recruitment advertisement in the Herald on the 27th of
January 2007?
Where is Pete Hodgson and his bits of data now to prove we don't have
a problem?
Contract, offer and commitment.....with whom and how many please Dr
Bierre!
Aside from all the same reasons we have heard many times since this
decision was announced, it contained one real reason, which
until now has not been discussed publicly:
"At
the end of the eight-year contract, the assets of Labtests' business
may be acquired by the ARDHBs, which will provide greater flexibility
in the future."
So after eight years working for Dr Bierre and Lee Mathias, staff at
Labtests Auckland then face the likely prospect of becoming public
servants working for Gary, Wayne and the ARDHBs.
Does this sound like the career choice a private health professional
would want to make?
There are other issues arising from this situation, such as the likely
level of investment expected from a company looking to turn a healthy
profit within an 8 year horizon. Labtests will have little
incentive to invest in the training and development of their people or
infrastructure. Why bother when their assets will be acquired at
the end of the contract for their depreciated book value with no
provision for goodwill. No smart private profit maximising
enterprise would invest hugely in such a situation.
I
suspect Auckland may suffer 8 years of underinvestment in community
pathology with the public purse picking up the tab at the end.
As for the staff, I suspect all our best and brightest will be lost.
There is a reason they chose to work in private healthcare, and it was
not so that they could become public servants again by acquisition of
their local health board.
------------
05 / 02 / 07 -
Is
this article
Testing time for our lab services an insight to what may happen in Auckland if the
courts do not overturn the community laboratory decision here?
"Well,
less than three months after the Medlab takeover, it begins to look
like the public's concerns were justified....the board can only be
judged guilty of doing exactly what it said it would not: downgrading
an efficient and highly-valued laboratory testing service. In light of
what it repeatedly promised, there can be no excuse for that. "
It would seem the article is suggesting that Medlab South, an
established and reputable lab with an excellent service history in
their area, are having issues taking over the Nelson/Marlborough
contract. I'm not a local, and I'm not qualified to judge
whether they are or are not delivering on their contract, however it
does lead me to ask the question:
Given this, how on earth could a completely new company be relied upon
to set up from scratch in a year and take over the tremendously larger
Auckland contract?
I
suspect health boards nationwide, motivated only by a short term aim
to save money, are effectively dismantling New Zealand's long
established, value-adding, highly respected and well performing
laboratory testing labs. The consequences of their actions will
likely not be fully realised for years.
In automotive terms they are abandoning the seasoned mechanics, and
regular planned vehicle maintenance for the designer who says his car
runs a bit cheaper because it doesn't need servicing.
We won't understand the folly until there's 30,000 kms on the clock
and the car blows a gasket.
"Our expected timeline for employment with
Labtests for Pathologists, Scientists and Technicians is as follows:
November/
December 2006: Call for interview
December
2006/ January 2007: Job Offer – acceptance
January
2007: Contract, offer and commitment."
So, now we have got through the senior recruitment period we should
expect an announcement about how many Pathologists, Scientists and
Technicians have been employed.
What does it mean that we have had no announcement yet, and where's
the
webcam you said would be live in the new year Tony?
------------
20 / 01 / 07 -
There is a well written and large article in the Weekend Herald today
entitled "Blood
on the lab floor". This article exposes some of the details
of the statement of claim and how
Labtests Auckland might try to rebut them.
A few interesting
points from the article:
"Bierre,
who told me a month ago he had more pathologist applicants than jobs,
verifies that five have signed contracts."
Ok, so with 6 weeks until his "innovative" lab gets up and running he
has less than 1/3rd of the required senior staff contracted.
After all the huff and puff about how well recruitments is going he
only has 5 signed. We know that Dr Bierre has flown overseas to
recruit. How many of these 5 contracted pathologists is
currently in Auckland, or worked in New Zealand before? This is
a real concern.
"He
points out that even if he loses the court case, DML will not
automatically get the contract back. "If the contract doesn't stand
you have to run it again," he says. "All this [backlash] means is
staff will miss out on good jobs."
While Dr Beirre is right, the outcome for
Labtests would be dire. If they lose the court case they
could well find their backer, Healthscope, pulls the plug. Their
history in Australia would suggest this is likely.
"He
also attended a meeting specifically to put together the Board's RFP
strategy and work out what they wanted from a provider."
It's up to the judge to decide if Dr Bierre gained an unfair advantage
from his position, however anyone who has worked with government
departments as a private contractor knows that the RFP process is an
attempt to create a level playing field for all companies tendering.
It's what's not in the RFP that matters about you and your
proposal. The only way to know what is really wanted is to gain
insight through other means, usually relationships. From the
relationships and position which Dr Bierre held, based on what is in
this article, you'd have to think that he was in a very unique
position to tender.
------------
17 / 01 / 07 -
The countdown is on to the court case and there has been very little
news, other than anecdotal, coming out of either camp of late. I
have been enjoying a summer holiday down at Ohakune, and just taking
some time to sit in the sun. However, work calls and now I'm
back into the swing of things.
As we get closer to the court case, and as
Labtests Auckland get closer to D-day, there will be more news.
"It’s not that the lights are on or off;"
said Garry Smith "they might be a bit dim and we will be able to
measure that.”
Garry, I hope you're reading that light meter carefully right now
because the distressed flickers I'm seeing leave me rather concerned.
------------
27 / 12 / 06
- Well I have heard rumours from several sources recently about
Labtests Auckland having serious recruitment issues. To date
we have had
no reassurance from the company, who are still unable to provide
any serious detail other than the warehouse they will build a lab in,
and a webcam they intend to put in it.
The only clue we have to go on is the interview Dr Tony Bierre did on
National Radio in September when he admitted they had
no contracted pathologists. As of this time I am unaware
that this situation has changed.
A
memorable post on the forum, by "Anne" which I felt deserved
republishing in my blog, neatly summarizes the views of many staff I
have spoken with lately:
"Anne:
This is an open letter to Tony Bierre. I
listened to you on RNZ on Dec 24 accusing DML of playing Russian
Roulette with our lives. Yes I am a DML employee (previously Medlab.
and I want you to know that not one operations manager or BOM member
at DML has EVER told me who I should work for or how long I shoud stay
with them. Like 100% of DML staff I have enough nous to Google for
myself the items re Healthscope & Gribbles. This is before I listen to
my colleagues who have worked with and for you in the past. They have
no wish to repeat the experience and believe me I have no intention of
experiencing it for myself. So enough already with trying to blame
some other party for lack of success in your recruiting endeavours.
Face reality."
There have been other stories recounted to me by
Diagnostic Medlab staff such as a rebuffed approach in their
workplace and phone calls. The latest new release from Labtests
Auckland calls for potential recruits to put their CVs in, rather than
update us as to the exact numbers. This is perhaps clue enough
to the trouble behind the bravado?
ps. Anne - please email me the details of that RNZ interview.
------------
19 / 12 / 06
- Well finally today an announcement from Labtests Auckland, however unlike them
I wouldn't go so far as to call it a progress report. You can
find it by
clicking here. One "innovative" move from Labtest is to
announce they will soon have a webcam up and running so people can see
how the warehouse they are retro-fitting is progressing.
As usual, the "innovative" move is nothing more than tinsel and
provides no real reassurance to anyone. The real issue right now
is recruitment. Anyone can buy a bunch of machines and stick
them in a lab. The trick is having people to run it effectively
and efficiently every day. On that front this release is more
like a call for recruitment than report on progress.
Of immediate concern is the fact that in this release Labtests
Auckland say:
"Labtests
have employed a “super temp” human resource management team who are
managing the recruitment process."
Is our new pathology service going to be run by super temps?
This is hardly a sustainable business model and must be
seriously stretching their wages budget. How fast will the
predicted savings take to evaporate?
If this was part of the original plan, then you really must question
the due diligence of the DHBs. Given we are now towards the end
of their stated recruitment period for senior staff, I find this
announcement quite concerning.
I
wonder if this is indicative of major recruitment problems.
------------
16 / 12 / 06
-
This morning I received a copy of the
Health Select Committee briefing from the ADHB and DML on the laboratory
contract. While the briefing is largely a précis of the
transcripts (included in the appendix), here are some of the
conclusions they came to after both meetings:
"..The evidence we have heard gives
us serious concerns whether the new laboratory service will be
able to process 10,000 patients and 35,000 tests per day from the
outset. If it is unable to do so we believe this could have serious
implications for the delivery of laboratory testing services to
the Auckland regional district health boards."
"We are seriously concerned that
the current levels of community laboratory-testing services to
Aucklanders is at risk."
"Some of us remain unconvinced that
projected savings of $15 million a year will be achieved without
cutting services. Some of us are concerned at the inadequacy of
contingency planning in the event that the new laboratory-testing
service is not fully operational and unable to start on day one."
Based on answers like this one below, I am not surprised they have
come to this conclusion:
"Sue Kedgley (MP) - Can you guarantee that as of 1 July next year
you will have a purpose-built laboratory capable of processing and
reporting approximately 30,000 tests, up to 10,000 patients a day?
Ross Keenan (ARDHBs) - Nothing can be guaranteed—I would be
foolish, we would be foolish....Any large contract has risk—that’s
life."
Here are some other interesting revelations to come out of the
breifings:
DML currently provides Auckland the
level of service it does with 25 FTE pathologists. The
briefing noted that Labtests Auckland proposed to operate with 16
pathologists. Depending on which report you read Labtest's
also claim that service levels will be maintained or
enhanced.
Equipment suppliers might be approached
to supply staff to run the equipment for a time after installation.
DML noted that the number of supplier technicians is very small, and
they may not be certified to work in New Zealand. This is not
their core role and how expensive would that be? $15m savings
down the gurgler pretty quick if that happens.
"Diagnostic Labs says that Lab Tests
told the Auckland DHB that it will reduce the number of collection
sites to 43 from the current 84, and indicated that it intends to
further reduce this number to an unspecified extent" "The Auckland DHB has not specified a minimum or maximum number of
collection sites, and will not make this decision. Lab Tests is
required to deliver a specified standard of service to the DHBs."
How many collection rooms will we have left and where will they be?
The number and location of collection rooms is absolutely key to
providing an adequate service. This should be a matter of
community and professional consultation.
Susan Turner, CEO of Harbour
PHO commented that a Waitemata primary care coalition delegation went to meet
with Labtests Auckland formed the opinion: "They said that, in their view,
they [Labtests Auckland] did not understand the way general practice worked, what was
needed to deliver the changes that they were seeking, and that their
perception of general practice in the design of this service was
they didn’t want to start to talk to us until February next year."
Susan also commented "We’ve had
meetings and tried to address it [concerns about the new
service] with them. They understood the concerns but they said
that at the end of the day it’s about money, that they were
saving $15 million, and we’re saying that this isn’t going to work
and that we’re really concerned about that for our patients, our
GPs, our community."
So in summary, Auckland finds itself in
a situation where:
Our tests might be sent overseas
We will likely have 40% less specialists
providing the service
Plan B is described as inadequate
We might have foreign technicians
running the equipment
We have no guaranteed number of
collection rooms
A PHO delegation think that Labtests
Auckland
don't understand their business, and don't want to talk to them till
February.
What exactly has the
Minister of Health done about this issue in the last six months to
reassure and protect the health of the people of Auckland?
------------
13 / 12 / 06
- In the absence of updates or further media reports, and while I still
seek permission to republish the NBR article, here's a few insights
from the entrepreneurial classic article entitled
Entrepreneurial Death Traps by Frederick J. Beste III:
"4. "Mousetrap" Teams
A handful of brilliant scientists or engineers disappear into a
basement and emerge six months later with an absolutely gee-whiz
prototype that by all rights should run circles around the competition
in the marketplace.
They have, in short, invented a "better mousetrap". The world, though,
to their great frustration and confusion, does not beat a path to
their door.
This should not be a surprise - no one on this team has ever
commercialised technology before. Doing this well is every bit as
difficult and specialised as coming up with the product itself. It is
absolutely critical that this talent be found in at least one key
member of the team, and preferably the CEO.
5. Inadequate Pricing
In my friend Bill Stolze's marvelous book Start-Up, he notes that
"there is no start-up strategy more likely to fail than one predicated
on being the lowest price competitor." Adopting such a strategy is
roughly equivalent to Luxembourg insisting on settling a dispute with
the U.S. with ICBM's. I would add that the statement which causes me
to lose my last meal the quickest (always accompanied by big smiles,
no less) is: "We're going to have the best product at the lowest
price!"
The message: Price to market. Gross margin is your best friend. It can
absorb all manner of adversity with two exceptions: philanthropy or
pricing stupidity (actually, in this case, the two are synonymous). "
The latest unconfirmed rumours are that Labtests Auckland are attempting to
recruit pathologists from the United States. It makes you wonder
if they might be falling into entrepreneurial death trap #5, and that
the plan was based on death trap #4.
------------
09 / 12 / 06 -
Great article written by Deborah Hill-Cone and published in the NBR
outlining DML's statement of claim, Labtest's statement of defence,
and querying the financial situation. I highly commend you to
buy a copy of the NBR and read it. I am seeking permission to
republish, as yet it is not available online.
A
couple of quotable quotes from the article:
"Dr Bierre has strenuously argued he managed his conflict of interest
conservatively by declaring it when he put himself forward to stand as
a board member, not attending board meetings where lab issues were
discussed..."
"But Diagnostic Medlab's statement of claim paints a picture of
someone still closely involved with the process behind the
scenes....detailed points in which they claim Dr Bierre was involved
in a high-level strategy discussion relating to lab testing, including
circulating confidential memos, giving advise and taking part in
presentations in confidential meetings on lab issues."
It is interesting to note that both Labtests Auckland and the health boards
fought the application by the NBR to get the statements of claim and
defence. To me this is just another example of the lack of
transparency around this whole process. They claim
their opposition is because the documents are one sided, untrue and
defamatory.
I
guess the judge will have to decide that one.
------------
04 / 12 / 06 -
So we're in the midst of a strike by lab workers in many DHBs,
click here for an interesting editorial about the issue.
As we see thousands of patients have their surgery postponed.
This is almost a dress rehearsal for what life might be like in
Auckland if Labtests Auckland are not up to the job next year.
Operations on hold
Doctors unable to access meaningful
diagnostic information
Patients needing a higher level of
supervision as a precaution
Costs, costs, costs, costs
The lack of information available to doctors could result in life
threatening missed, or mis-diagnoses. While this is a short term
strike, where employees will go back to their jobs, with Labtests, if
they are unable to hire, it won't be a one week issue, it could go on
for months.
One thing's for sure, if they aren't offering decent rates then they
are unlikely to attract the talent they will need to run a lab.
If they are offering decent rates, then you'd have to wonder about the
viability of their budget, given so many of their other "innovative"
ideas appear to have been pushed to one side.
It's been over a month now since Labtests last announcement, and
according to their timeframes they should be interviewing and offering
jobs now. No news is good news?.....I'm not so sure.
------------
29 / 11 / 06
-
NZDoctor did a story on the
Colmar
Brunton research which showed that GPs backed Diagnostic Medlab to
retain the contract, over
Labtests
Auckland.
While slightly out of scope, of interest to me lately has been the lab
workers strike affecting the DHBs throughout the country. Here
are links to articles about this debacle:
This issue poses a rather interesting question, given rumours that
Labtests
Auckland are offering lower pay rates than DML. If you can
substantiate those rumours with a copy of an actual job offer please
contact me.
How are Labtests going to recruit staff,
and when will they give us a progress report?
So far all we've had from Dr Bierre is puffery about recruitment, no
hard data. It's about time we had some hard data on this issue
because it really is the crux of the whole matter. Their
business case falls over flat on its face if they can't get the staff.
So if DHB staff are striking for higher pay, why would DML staff even
consider moving to
Labtests for lower pay, when they know that
Labtests are dead in the water if they can't recruit?
The DHB lab workers strike shows that this industry is already on the
boarder line in terms of pay, and it's well known there are staff
shortages New Zealand wide. To me, this alone proves the
short-sightedness of the decision to award the contract to a cut price
provider. When talent is in short supply surely the riskiest
course of action is to cut the wages budget, make everyone redundant,
and force them to reapply for their jobs.
The arrogance of the DHBs in awarding this contract to
Labtests
Auckland is
breathtaking, and I am predicting it will backfire on them
spectacularly.
------------
23 / 11 / 06
- A quote from
Labtests response to the poll:
"This poll tends to
perpetuate the misinformation that has characterized Diagnostic
Medlab’s response since Labtests was awarded the new contract"
Ok, so who's misinforming who about what? Try these quotes, also
from Labtests:
"Turnaround times
will be decided in consultation with referring doctors and so will be
clinically appropriate." LTA's
19th July
"Labtests is moving
quickly to put into action its advance planning so that people can
start to see for themselves" -
LTA
4th Aug
------------
22 / 11 / 06
- A
tale of two press releases. One states facts, figures and
real
responses from GPs and Aucklanders as measured by a professional
research company. The other contains rhetoric, reassurances and
yet again no detail of any value. Compare this:
"A quantitative survey of the region’s
general practitioners (GPs) carried out on behalf of DML by
independent research company, Colmar Brunton, reveals that 92 percent
of the Auckland region’s GPs would prefer DML to continue to provide
community laboratory services for the Auckland region."
and this
"More than 90 percent of GPs believe
maintenance of current turnaround times for routine blood tests is
very important;
More than 80 percent of GPs feel that 43 collection centres will be
too few;" -
DML Release 21 Nov
With this:
"Labtests Auckland will maintain or
improve turn around times for routine blood tests....Labtests are putting in place a specimen
collection service that will meet the access issues of our population
particularly the special needs of the high needs groups.
We are investigating innovative and reliable ways of transporting
specimens to our laboratory." - LTA Release 21 Nov
Still investigating....how does that tally with this?
"Labtests is moving
quickly to put into action its advance planning so that people can
start to see for themselves" -
LTA 4th Aug
Eight months out from the biggest community health experiment of my
lifetime where is the evidence of all that "advanced planning"?
All I can see for myself is empty rhetoric, reassurances, and a
warehouse yet to be converted into a laboratory.
Where are these collection centres going to be located?
What are the turnaround times going to be for each test?
How many applicants do you have and who have you hired?
Who has agreed to provide point of care collection?
It's time to stump up with the details Tony.
------------
21 / 11 / 06
-
News about a survey, commissioned by DML, but carried out by
Colmar
Brunton, of GPs and the Auckland public has appeared on TV3 and
Radio New Zealand.
To quote from the Radio NZ story:
"90% of Auckland GPs want the company to retain the service....
Diagnostic Medlab's chief executive, Dr Arthur Morris, says the survey
also found that 75% of GPs were unwilling or unable to collect blood
at their practices."
Consider the GPs response, then juxtapose it with this quote from
Labtests on the 19th July:
"We welcome the opportunity to answer people's questions and to
discuss how Labtests Auckland will deliver enhanced, better value
laboratory services to the community from July next year."
They have had almost five months now to answer the questions
and have discussions. At the end of that time a grand total of
1% of those surveyed preferred Labtests, 92% preferred DML, and 6%
were indifferent or did not know.
The population of Auckland, and GPs, are the consumers of this
service. Both
overwhelmingly support Diagnostic Medlab and
prefer them over the alternative. I'd say that's a pretty strong
mandate from the electorate to spend a bit more money and maintain the
service provider and current service levels.
DML have got their bits of data together to prove their point.
Where's Pete Hodgson with his?
------------
17 / 11 / 06 -
Click here for a release from the BOP DHB where they announce that
the contract for community pathology services in the region has been
awarded o the same company, Pathology Associates Ltd.
To quote from the BOP DHB release: "“One of the key outcomes achieved
as is that the population of the Bay of Plenty will continue to have
access to high quality laboratory services,” says Mrs Mason."
If only Auckland
was lucky enough to have the same continuity of service.....
------------
14 / 11 / 06 -
In a timely reminder about how resource and staffing shortages can
affect a laboratory, I read
this article in the Herald this morning about the lab at Waikato
Hospital. While at this stage the move by IANZ looks
pre-emptive, and they say that no patient has been put at risk, it is
suggested in the article that issues have existed for sometime at the
lab before being picked up on.
Let's hope they sort it out before anyone is affected.
Do we really want to risk our health on a lab which might have
staffing or resource issues in Auckland?
------------
09 / 11 / 06 -The NZMA, Royal College of Pathologists and National Party all put out
releases today about labgate. The headlines speak for
themselves:
The Auditor-General reveals that there is real difficulty establishing
how large sums of scarce health dollars have been spent.
For a small sum, in the scheme of things, the government can guarantee
the population of Auckland continued access to a world class and
sustainable community laboratory service, which can fully account for,
and justify, all its spending.
With overwhelming public and expert support for a review of this
decision, it is clear they will be held accountable. I wouldn't
be risking my political career on this experiment...why are they?
------------
07 / 11 / 06
-
Someone on the forum alerted me to the latest release from the health
boards, which can be found by
clicking here. The health boards are seeking urgent talks
with DML regarding transition arrangements. One point springs to
mind - why should DML assist or participate in any transition that may
or may not happen? Sounds odd to me.
Why would DML lay down misere so to speak, when it may not be
necessary. All I can say is that by delaying the court case till
February, the DHBs have scotched any possibility of transition talks
for now. If they were committed to workforce transition, and
were confident in their "robust" process, surely they would have
proceeded with the court case as originally planned, win, then sought
transition talks.
Anything else is wishful thinking, as is the possibility of staff
running to the new provider. Comments from Gary Smith around
giving DML staff first option but, reluctantly, looking offshore for
staff, looks like nothing more than a desperate tactic to unsettle the
workforce.
If I worked for DML right now I'd be sitting tight. Why sign up
to work for an entity that could be rendered inoperable with the
stroke of a judge's pen?
As for getting the dates wrong on their release, the pressure is
obviously taking its toll. Labgate rolls on......
------------
06 / 11 / 06 -
Insightful and well researched article in the NBR. It is not
published online so I cannot link directly to it, however here are a
few quotable quotes:
"Like the pledge card debate, this High
Court case raises some significant issues for the government, with the
credibility on trial of Labour favourite Wayne Brown, the chairman of
the Auckland District Health Board."
"He [Dr Bierre] took a personal grievance
case against DML but was unsuccessful, with the Employment Relations
Authority describing part of his evidence as disingenuous.
Rosemary Monoghan ruling for the authority said Dr Bierre saw himself
as "in the role of the unappreciated advocate for improving quality
standards and an unheard voice begging for improvement in
communication within the organisation. However, rather
than agreeing he was not heard, I would say that...he was not prepared
to listen to other points of view with any great degree of open
mindedness."
The article also quotes Dr Bierre as saying:
"When even any lab issue came up before
the board I reinforced that to the extend [the rest of the board] got
a bit sick of me saying I had a conflict of interest. I said it
on numerous occasions in board meetings..."
How soon after joining the board did Dr Bierre start declaring his
conflict of interest? If Dr Bierre knew he had such a clear
conflict of interest then I ask why he stood to be elected as a
candidate for the board in the first place.
The fact that he stood down from the board not long after being
awarded the contract really makes you wonder about his motives.
I
highly commend anyone interested in labgate buys a copy of the NBR and
reads this article.
------------
05 / 11 / 06 -
The NBR appear to have run a solid article about labgate, the Auckland
community laboratory issue, in their latest edition. Whilst I
have yet to read it, some of the quotations posted on the forum make
for very interesting reading. I will be buying my copy of
the NBR tomorrow.
The forum has been quite heated in the last few days. The move
by the health boards to delay the court hearing has certainly raised
tensions and uncertainty. It makes you wonder how transparent
and robust this decision was when the challenger is ready to stand up
in court and you're still working on your defence.
------------
03 / 11 / 06 -
This campaign has no political affiliations but I couldn't resist
modifying "that billboard" for humorous purposes. I believe
recent events justify giving this escalating debacle a name, I suggest
we call it Labgate.
I
hope Pete Hodgson has gathered his "bits of data" and is about to act
swiftly, because by kicking this issue into touch until February the
health boards have heightened workforce shortage risks, undermined the
implementation plan of their new provider, and further risked the
health of Auckland.
Gary Smith talks about sense and ethics. A sensible and ethical
health board would put the welfare of patients first and admit they
made the wrong decision. The workers and the public have both
said they don't want a new provider.
Does the health board have the wisdom to foresee that the new service
is untenable without workforce buy in, and go back to the drawing
board with this flawed decision making process?
I
hope so. If they get this wrong they are not only putting their
own positions at risk, but those of their political leaders.
If Pete won't take notice, perhaps it's time Helen did.
------------
02 / 11 / 06 -I
am still wanting clarification about who went to court seeking that
the hearing be deferred. According to the forum it was the
ARDHBs, however a release they put out tonight suggest it was DML who
were responsible for deferring the hearing.
Whoever sought to defer the case is obviously not confident and needs
more time to prepare. Surely if their tender process was so
"robust" the ARDHBs could turn up in court at a moments notice and
defend it.
Exactly who has put the staff in limbo
because of this decision ARDHB?
Deferring the case only serves to further undermine the workforce and
give them every reason to leave town. If I worked for DML,
here's how I'd see my options right now:
A) stick with DML and guarantee employment till July 1 2007
B) move to Labtest Auckland Ltd where I may or may not have a job
after the hearing in February 2007
C) leave town now
I
cannot imaging anyone wanting to leave their existing job, with their
current employer, to work for a new company that has only just
established a lease on their main premises. DML exists now, has
a collection network, and high tech purpose built laboratory.
Labtests Auckland Ltd have a contract for now, and a lease on a
building, but will they have anything by the end of February?
Who knows.
------------
30 / 10 / 06
-
The issue around pay and conditions is one that is starting to feature
more prominently on the forum right now. There has been no
formal announcement from Labtest about this, but the rumours and
expectation are that the pay is significantly reduced.
If anyone is able to provide concrete evidence of the pay rates
Labtest Auckland Ltd will be offering phlebotomists, pathologists or
lab workers, please let me know. For now I believe it is mere
speculation.
------------
26 / 10 / 06 - A good point was raised
on the forum today by Peter:
"How
long before Specialists realise that sending patient back to GP/PHO
for Lab tests and having a copy of report sent to them save money for
patients. And legally I dont think the DHB can stop this from
happening in the future."
I
don't know about the legality of it or otherwise. What I do know
is that GPs and Specialists are more likely to act in the best
interests of their patients than the DHBs budgets, so it is quite
probable that what Peter suggests will happen.
These cost shifting measures are surely futile. They don't pass
the common sense test. Anyone with a creative mind can see the
obvious loop-hole. It really makes me question the foundations
of this decision.
Do these bureaucrats make decisions like this simply to cost shift and
further enhance their bonus?
Is the fundamental problem here that they are motivated by the wrong
incentives, short term budget gain, long term public pain?
"Pete Hodgson is not
ruling out the possibility of the policy being rolled out nationwide."
Cost shifting isn't a
clever way to save money or win votes. This will undoubtedly see
patients needing expensive or repetitive tests opt back into the
public health system. It will also likely push up
healthcare premiums already under considerable pressure.
Save a penny here that
I can measure, and spend a dollar there that I can't. End result
- more demands on the public health system.
What has gone so wrong
at the DHBs that they pursue short term, budget driven and cost
shifting policies, without proper consideration for the long term
consequences. Has anyone done a study to quantify how much of
those "savings" will likely be re-spent in other ways directly as a
result of this decision? If so I'd like to read it.
------------
24 / 10 / 06 - I note with interest
that the
Association of Salaried Medical Specialists are “assertively
challenging” the WDHB’s provisional decision because they believed it
was based on unreliable and misleading information.
Mr Powell of the ASMS
says “The WDHB’s decision fails to comply with a new government
protocol which requires that it actively and constructively engages
with the health professionals involved in the provision of the service
and to explore other means of achieving the DHB’s objective.”
How does the Auckland
DHBs decision comply with the new government protocol? Based on
my understand of the intervention judgment it would appear that the
court case will be examining this.
I personally support
their challenge and Dr Boswell's call for a national strategy.
Pathology is an industry with a worldwide labour shortage.
New Zealand cannot afford to take a gung-ho attitude to reforming this
industry because we risk alienating the already slender workforce.
This is an opportunity
for the government to show leadership, make good on the knowledge wave
rhetoric, and direct these changes at a national level. I ask
the government to create a comprehensive national strategy to ensure
workforce continuity and address the sustainability issues.
From an economics
perspective, it is obvious that each DHB, acting in their own economic
interest, will behave in a prisoners dilemma fashion. They will
not individually make decisions which maximise the common good.
Given the specialist
nature of this industry, and the fact that DHBs have an incentive only
to act short term when awarding these contracts, it is surely logical
for the government to step in and direct this issue with a national
view, for the nation's good.
------------
23 / 10 / 06 - 13 police cars and 2
speed cameras later I made it back from Paihia to Auckland today.
It felt very safe on the roads despite the wet conditions.
Having a weekend away to sit and contemplate life somewhat. I
reflected on this, posted on 16/10 on
LTA's website:
"This weekend will
see the beginning of Labtests advertisements for Heads of Departments
for each Laboratory Specialty. Labtests is planning to employ these
positions as soon as possible.
They are exciting
opportunities which will allow these managers to be involved in the
technical aspects of the establishment of a major laboratory. This
really is a once in a life time opportunity for people suitably
qualified for these positions."
Presumably, many of the
Heads of Department that Labtests Auckland are referring to, are currently
working at DML.
How can these HODs
be in two places at once for the next eight months?
If they stay at DML,
then how can Labtests Auckland possibly get up and running. Surely that
expert input will be required to establish a new laboratory.
If they move to
Labtests Auckland, how will DML continue to function, and see out it's
contract?
It makes you wonder
just how feasible this robust plan really is.
------------
19 / 10 / 06 - Congratulations go to
Harbour PHO who have been allowed to intervene in the judicial review
of the community lab contract decision. To read the full
judgment
click here.
This is a great
decision because it will allow the PHO to represent the interests of
their members, and by default those of many others in the hearing.
I believe that the consultation was totally inadequate, and I am
confident that they will be able to argue this successfully.
As I read the judgement,
what it says is that Harbour PHO has adequately demonstrated that it
has a direct interest in this decision, an interest that would not be
adequately protected by DML when presenting their case. The rest
of the interveners were dismissed on the grounds that the Harbour PHO
would adequately represent them, or they had not put forward a
sufficient case.
So, while not all
interveners where successful, one was, and I think ultimately they
will fall in behind the Harbour PHO, whom I hope will present a strong
and robust case.
A partial success, but
a fantastic and significant one none the less. The fact that the
DHBs and Labtests Auckland both opposed this intervention, to me, shows nothing
more than their desire to paint this dispute as a commercial contract.
It is clearly far more
than a commercial contract. This is a human decision which has
serious implications for the the lives of Aucklanders, and the team
that staffs community laboratory in this region.
17 / 10 / 06 - The New Zealand
Association of Pathology Practices have
joined the call for a moratorium on changes to community
laboratory services. How many more groups need to put forward
their case before the government will take some action? It is
surely clear now that they cannot remain disinterested and at arms
length from this issue.
A little birdie pointed
out these
meeting minutes from the CMDHB meeting on 9th September 2006.
Interesting section on the lab conract:
"Labs Project
· The project is now in the implementation phase
with key individuals from Labtests Auckland leading each of the
project areas.
· The judicial conference has not slowed down
proceedings from Labtests perspective and Mr
Mules noted that the hearing is focused only on the
tender process.
· Board members expressed anxiety around monitoring
and requested detailed reports on key milestones in the implementation
plan.
This was deferred to the Confidential section of
the meeting."
A couple of questions
I'd like answered:
Which board members
are expressing anxiety?
What detailed reports
have they requested?
Why was it deferred
to the confidential part of the meeting?
Well spotted little
birdie!
------------
16 / 10 / 06 - A great
news report about the laboratory situation was on Radio NZ last
Friday. A quotable quote from Dr Bierre about "rhetoric" from
pathologists:
"I think that they
should actually front up and provide some hard information about what
they are talking about. They obviously haven't convinced the
minister and they certainly haven't convinced me."
The Medical
Association, several GPs, specialists and primary health organisations
are trying to front up at the judicial review, but Labtest and
the DHBs
opposed their application to intervene.
I wish Dr Bierre and
the DHBs would front up and answer our questions.
------------
15 / 10 / 06 - I spoke today with an
experienced nurse who said she had received a visit from Dr Bierre and
Lee Mathias in her place of work (a DML collection centre) to solicit
her for potential employment. If this is their recruitment
strategy I think it is deplorable.
Placing advertisements
in the paper and writing to them is one thing, ringing them is cheeky
but acceptable, however turning up in someone's place of employment to
solicit their CV is, she felt, intimidating. I would agree.
Her reaction was
praiseworthy. A polite "thanks, but no thanks". She is one
of the many whom I have spoken to eyeing future employment either out
of Auckland, or out of New Zealand.
An experienced nurse
with 10+ years experience who would rather leave town than work for
the new provider. You go girl!
What a tragic loss
of skills and experience for Auckland.
Another interesting
thing which she discussed with me was the relationship which is formed
between patient and nurse if regular testing is required. Taking
blood from someone is a very personal thing and for someone who
requires regular testing, developing trust is crucial. She
recalled many patients or hers or her colleagues who would insist on
having their blood taken by one person they knew well and trusted.
Along with the doctor
and patient, community pathology completes the primary health
triangle. Where is the impact assessment and evidence of
consultation with patients about this change? If it exists I'd
like it tabled so we can all read it.
------------
13 / 10 / 06 - The New Zealand Medical Journal has an
excellent article about the
laboratory issue released today. A couple of quotes from the
article:
"Legalistic process and devices such as
probity reports have been used as a shield from criticism by DHB
planners focused on reduction of cost and business risk.
Clinical service consequences and clinical risk seem to have little
influence in the final selection of providers."
"When service reporting workloads reach
the point where there is insufficient time or enthusiasm for optional
tasks, pathologists will withdraw and retrench out of necessity.
This can only become apparent after time, and reengaging the
disenfranchised will be difficult."
"The changes will inevitably result in
disruption of established clinical relationships....The changes result
in clinical risk."
"The changes open new
possibilities for cost-shifting and service reduction, and may work
against innovation."
"When service reporting
workloads reach the point where there is insufficient time or
enthusiasm for optional tasks, pathologists will withdraw and retrench
out of necessity."
"It is hard to escape a conclusion that in
pursuing this disruptive and risky course the DHBs may be penny wise
but pound foolish...When the chickens come home to roost, many of the
managers responsible for these changes will have moved on, leaving the
profession to contend with what may be a far less attractive future
for those who remain."
------------
11 / 10 / 06 -
Aucklanders react strongly to Health Minister's reassurances is
the latest media release from Dontriskourhealth.com, echoing your
comments on the forum, and challenging the Health Minister to wake up
and get involved in this issue. As the NZMA, ASMS and College of
Pathologists have said: the crisis is here now.
The Government needs to
step in and act.
Key points to ponder:
Pathologists and
staff of DML have said they do not want to work for the new
provider.
The pathologists and
laboratory staff are highly trained knowledge workers who are in
strong demand worldwide.
Why would they stay
here out of sense of duty, when the
Auckland DHB
chair suggested they could work for the new provider or drive a
taxi?
Once these
professionals leave there is little chance they will come back.
------------
10 / 10 / 06 - It is astonishing that
with so many national and international expert groups, such as the
WHO,
NZMA,
Royal College of Pathologists, PHOs, and the
College of
GPs all warning about a pending disaster in community pathology,
that the Government's reaction is, from Health Minister Pete Hodgson:
"[We] are confident that the fair
and open tendering of lab contracts should not negatively impact on
the number of pathologists working in New Zealand". (full article
click here)
In my lifetime I have
never seen so many groups be so outspoken and united with concern
about a health issue. 100,000 Aucklander's have also signed a
petition calling for a review of Auckland's lab contract decision.
How can any responsible
government dismiss such a vocal outcry?
Points of interest
from the Auckland meeting are items 1,2 and 4. In the Waitemata
minutes item 3.1. Some thoughts after reading the minutes:
Far from welcoming
the delegation, Wayne refused to meet the delegation but changed his
mind when the media arrived.
If during the RFP
process a decision had been made not to use the hospital
laboratories why, shortly after being awarded the contract, was Dr Bierre looking for spare capacity within the hospital system?
Click here for that news article.
The irony of
juxtaposing a decision not to release the roadmap with a notation
that misinformation is being spread.
If they would answer
the questions of GPs and the public instead of making endless
reassurances and use the word "robust" all the time there might be
less speculation about what is happening.
Pretty basic really.
------------
05 / 10 / 06 - Dr Ross Boswell of the
NZMA today released a statement entitled:
Risks to
laboratory services increasing. He is calling for a
moratorium on any further changes to laboratory services until a
national policy can be created.
We support that call
and encourage you to read the release. The key points made are:
"a. There is a complete absence of a
comprehensive national policy
framework for the provision of laboratory services. As a result, DHBs
are making critical strategic decisions about services in a policy
vacuum, based entirely on local or regional factors and perspectives.
b. There is an over-riding context
of trying to find cheaper ways of purchasing laboratory services in
order to meet budgetary targets, to the potential detriment of
sustainability, quality and safety. There is considerable risk that
this drive to cheapness may lead to the penalising of associated
clinical services by cost-shifting.
c. National implications for
workforce and the long-term sustainability of laboratory services are
not being attended to, and there is consequent risk that services may
collapse locally or nationally. "
New Zealand's DHBs are
overhauling this industry region by region, and opting for the
cheapest provider, ignoring all the expert advice and refusing to
listen to stakeholder views. This is reckless, dangerous, and
poses a serious risk to health in New Zealand.
Community pathology
underpins diagnostic medicine. Decimating the morale and
destabilising the employment continuity of professionals in this
industry will result in early retirements and relocations
overseas.
Once they're gone,
they're gone. We will be the losers.
There is no one to
replace them.
Are you comfortable
with that....I'm not.
------------
04 / 10 / 06 -There was
a comment on the forum today which requested more information about
who is behind the site, and what the motivation was for setting it up.
Who I am
and why I'm involved has
been well reported in the media. I haven't made a big deal of it on
this site because I didn't want it to detract from the issue.
However, the questions raised are reasonable, so for those of you who
haven't read the media reports, here's the background:
My wife
works (update: worked) for Sonic Healthcare in a junior admin role. I got
involved in this issue when she brought home the petition.
The site
was setup of my own volition. After researching the issue, and
canvassing views from all the medical professionals I knew, I was so
concerned that I decided to collect petition signatures myself online,
and create a public forum and news hub. Aucklanders need a voice
in this debate.
I speak
for myself, and on behalf of all the people who have, since seeing the
site, joined the campaign with me.
I am
concerned that Auckland's community pathology service is at serious
risk and this poses a threat to public health. My motivation is
to see the best decision made after proper consultation with
stakeholders.
Self
evident by the reaction of industry and the public, the community
consultation before this decision was made was totally inadequate.
If the right decision has been made then after consultation it should
stand, but this decision has not been made the right way, and so it
needs to be reviewed.
To quote
from my first blog posting:
"This is a campaign I
have launched of my own accord and volition because I'm fed up with
elected and appointed public servant bureaucrats making decisions, on
behalf of their constituency, without genuine
consultation. This time it has really hit home: they don't
care what we think. Their primary concern
was cost, not my welfare.
That is very very scary. "
------------
02 / 10 / 06 -Less than
48 hours after you heard it first on the forum, Labtest have
announced their new lab at 37-41 Carbine Road, Mt Wellington.
It makes interesting reading.
------------
01 / 10 / 06
-
Click here for a report about the rally last week. On the
forum there has been some talk about location of Labtests Auckland lab, and
suggestion that it will be a dual purpose facility.
This is
an unconfirmed rumour and I will make enquiries to confirm it's
authenticity. If you can corroborate this speculation -
let me know.
------------
26 / 09 / 06 -
Congratulations to the Counties-Manukau DHB for
receiving the petition and protest today. They, like the
Waitemata board, have set an example to the Auckland DHB. We
await their formal response. It's never too late to review a bad
decision.
After
speaking to several of the pathologists today, I have serious doubts
that Labtest will be able to retain the expertise needed to run the
new lab. While they were committed to Auckland and Diagnostic
Medlab, all of them had been offered jobs in Australia, and all of
them said they refused to work for Labtest.
The
pathologists I spoke to objected to working in a cut-price
environment. They were proud of the high quality of service they
offered Auckland now, and said they would not compromise their
professional integrity by working for a provider who may be under
staffed or under resourced.
Australia
has a shortage of more than 150 pathologists right now.
Australian labs could employ the entire pathology staff of DML and
still not solve their shortage crisis.
With
better pay and working conditions beckoning overseas, why would they
stay here and work for a new provider offering a Toyota style lean
thinking environment? They work with people, not cars.
------------
25 / 09 / 06 - Rally tomorrow at 19 Lambie Drive outside
the Counties-Manukau DHB meeting, 12:30pm. See you there!
WHO warns
that rising workforce exodus threatens health systems
In an
aptly timed announcement (click
here), the World Health Organisation
said today, from a committee meeting being held in Auckland, that the
rising workforce exodus to wealthier nations presented a serious
threat to health systems.
The
situation facing Auckland’s community pathology service is a prime
example of exactly what the WHO is referring to. To quote from the
release “If present trends
continue, this worsening shortage will push health systems to the
brink of collapse…”.
With the rhetoric
coming from
Dr
Bierre like “They’ve got no where to go” (click
here) and Wayne Brown: “They can work for the new provider… or
drive a taxi” (click
here), a shortage is
looking increasingly likely. DML staff have strongly protested this
decision, and said they would rather leave Auckland or retire than
work for the new provider. Why would they choose a cut price provider
offering a lab in ‘…any
suitable factory building’, as Lee Mathias
put it, over a foreign job with better wages and working
conditions.
Pathology
Collectors Course
Since the last
newsletter a training company offering a “Pathology Collectors Course”
has appeared from Australia and started advertising for students.
They didn’t have a website for New Zealand, but you can read the
advertisement:
click here.
I have
requested an information pack, but while I wait, I wonder how they
will train a pathology collector in 2 days, while every other course I
have seen takes from 6 weeks to 2 years. Amazing!
Auckland has
plenty of trained phlebotomists, and the new provider has already
announced the majority of cut backs will be in this area. Is the new
provider going to replace them with people who only have two days
training?
I sure wouldn’t want these trainees taking my bloods!
------------
21 / 09 / 06 -According to Dr Bierre,
Auckland only needs 40 collection centres. Should we be grateful he is
supplying 43?
Here is a "per head of
population" comparison showing how many collection centres other
cities have (highest to lowest):
City
Population
Rooms
Equivalent to Auckland
Melbourne
3.6m
398
176
Brisbane
1.8m
188
167
Sydney
4.3m
414
154
Vancouver
1.1m
67
97
Hobart
250,000
14
89
Auckland (before)
1.6m
84
84
Auckland (after)
1.6m
43
43
Auckland already has
the lowest number of collection centres per head of population and now
that is going to be halved.
I'm all for efficiency plans, and if point
of care collection can be done that's great. However, the new
provider has signed a contract, promised Auckland better access
to collection facilities, without prior agreement from the PHOs
that will be relied upon to provide this service. They have
already indicated they are unwilling, so what is Labtest Auckland Ltd
going to do?
Is
this visionary or very scary?
19 / 09 / 06 - The Nelson-Marlborough
DHB have
announced their decision to award the community lab contract to
Medlab South in yet another DHB decision which has been met with
fierce local opposition.
Not surprisingly, the
dumped provider is considering legal action.
It is time for the
government to urgently review the national community pathology
strategy. These changes are seriously undermining the industry
and creating a long-term risk to New Zealand's health.
We are already short of
pathologists. The short duration and unpredictability of the
DHBs when awarding these contracts, largely on the basis of price,
will encourage underinvestment in people and facilities, and
ultimately lead to a decline in service levels. It will
inevitably create an environment where providers take risks to cut
costs, and the consequences could be fatal.
The short sighted, save
at all costs, mentality of the DHBs is ruining the health system.
Junior Doctors, Radiographers, Pathology...a pattern is emerging.
While they save money in the short term, we will all pay big time in
the long run.
Remove the
paper-shuffling, form writing bureaucrats from the system now.
This will provide ample money to contract sustainable service
providers who will invest in, and foster, the professional community
and standards required to provide a world-class health system we
expect.
------------
14 / 09 / 06 - What other changes are
in store with the new provider? Well if
this letter
by Heather Roy is anything to go by then all of you who pay for
healthcare twice by taking up private health insurance may be about to
pay for your testing twice too.
Is this part of the
"innovative" approach to laboratory testing that we have been promised
from the new provider, yet to be announced? Is making private
specialist patients pay for their own tests just one of the ways the
new provider expects to save money for the DHBs?
I am starting to get
very uneasy about the fuzziness and total lack of detail from the DHB
and new provider about the new system. It is making me anxious
that they won't tell us where the new collection centres will be,
where their lab is, who their staff are and which GPs have agreed to
do point of collection testing. The longer they delay the
details the more I suspect that Aucklanders are not going to like the
results.
------------
13 /09 /06 - Another great rally,
this time outside the Waitemata DHB meeting today (click
here for RadioNZ report).
Congratulations to the
Waitemata board for their decision to accept the petition and front,
with chairman Dr Dwayne Crombie mingling in the crowd before the rally
began in earnest. Reports suggest that during the presentation
the board took an interest and engaged the pathologists who presented
the petition.
They are to be
applauded for their open mind. Their real challenge now is to
admit that this contract was awarded without adequate stakeholder
consultation, and review the decision. Be brave Waitemata DHB,
do the right thing by your constituents!
------------
12 / 09 / 06 -Quote of the day from
Chris Gallagher of the Nurses Union -
"Auckland
community is already under-resourced in comparison with worldwide big
city centres and this decision to use a new unknown company whose
current expertise is in animal testing is not be supported by our
Auckland community."
LOL. I wonder if
they'll get vets to do the testing, because it doesn't look like we'll
have any pathologists.
Here's some interesting figures for you.
This from
Healthscope's news site announcing the contract:
Margins:
• EBITDA margin expected to be in the range of 15 to 20%
over the contract term. Investment: • Initial development costs and capital
assume requirement to establish service from ground zero. • Have been estimated to be at approximately $NZ18.0
million
How does this sit alongside this statement
from
Dr Bierre: "We are not a cut price
operation at all, we will be taking less profit..."
How much of the $15m savings are less
profit, and how much are cutbacks, cost shifting, and wage cuts?
You really have to wonder.
I can't explain an $18m investment to win
a $560m contract. I understand just DML's lab alone cost over
$50m. What sort of lab and collection network are they going to
setup with $18m?
------------
11 / 09 / 06 - Busy last couple of
days. I have now overhauled the front page to make it more
interactive. I hope you have voted in the online poll!
Yesterday I sent out
the newsletter and a press release about the rally this Wednesday 1pm
at Lincoln Green on Lincoln Road, outside the Waitemata DHB meeting.
Great response and feedback from you all about it I look forward to
seeing you there.
------------
07 / 09 / 06 - Great protest,
brilliant coverage. Despite initially refusing to accept the
petition, the ADHB reconsidered. In the face of overwhelming pressure
they did accept it in the end.
Click here to
see One News coverage of the picket.
What does this show? Bad
decisions can be reconsidered!
The challenge for the
DHBs now is to read the petition and public submissions, take stock,
and review the lab contract decision.
Wayne Brown's comments
I can only describe as sad:
"But DHB chairman
Wayne Brown is unmoved and says critics need to get over it. "They can
either work for the new company or...drive a taxi," says Brown."
Article
How can someone with
that lack of respect and empathy for health professionals possibly make good
decisions on behalf of the Auckland public? I wonder if that
sentiment is shared by his elected colleagues on the board, who will
be seeking re-election shortly.
If they value their
positions, they would be well advised to listen to the public who
elected them into office. We will not accept our world class
pathology service being put at risk.
------------
06 / 09 / 06 - TV3 and Radio New
Zealand have both aired excellent articles about the lab contract
and picket tomorrow. I thank them for their quality reporting
about this issue.
Well it has been
another flurry of activity in the last 24 hours. TV, radio and
lots of discussion on the forum. Your petition submissions and
all the comments posted on the forum have been printed out and will be
included at the picket tomorrow. Thank you to all those who have
commented or signed the petition.
A few quotes from
Dr Bierre from this mornings radio interview :
(any errors or misquotes please bring to my attention and I will correct immediately)
"Recruitment is already
underway, well underway....We have not contracted any pathologists as
of yet, but we have had expressions of interest..."
"We haven't got to the
stage of contracting with anybody yet. We're still developing
our HR systems. We have employed an HR consultant as of Monday,
so that process is well underway."
"...by the first of May
we will be opening a full service laboratory so that we will have
collection facilities in place..."
"We have an
implementation committee that consists of 9 people. 6 of those
have started laboratories of this size before in the past (Kathryn
Ryan: from scratch?)...from scratch...(Kathryn Ryan: "In a new
city in a new country")...yes."
"We are not a cut price
operation at all, we will be taking less profit..."
"This is a significant
contract for the people of Auckland it means they will get a better
service than they have had in the past"
Questions which I think
need answering after hearing that interview are:
How realistic is it
to say that the recruitment process is "well underway" when you only
employed an HR consultant on Monday and have no contracted
pathologists with 8 months till 1 May when your full service lab
is going to open?
If Labtest are going
to have a full service laboratory up and running by the first of
May, who is going to be working at DML laboratory for two months
till 1 July processing 30,000 tests a day?
Who are the 6 people
working for Healthscope who have started a laboratory of this size
before, from scratch, in a new city in a new country, and in what
timeframe did they do this?
If Labtests Auckland is not a
cut price operation, how much are they going to pay the staff?
Posts from people on the forum have suggested the rate of pay for
lab workers and phlebotomists is lower than DML.
In what ways will
Labtests Auckland's service be better? Two months later and we have yet
to get the details outlining how they are going to trump the service
offered by DML. Stump up with the details Dr Bierre. I'm
getting tired of rhetoric, particularly the word "robust".
Here is a link to a
very interesting set of meeting minutes from Northern Regional DHB
Coordination Meeting 9 June, 2005 at 3pm
click here. I quote from these minutes:
9 - Laboratory
Project Tony Bierre (Board member ADHB) and Bruce Gallop were introduced to
the meeting at this point.
A considerable discussion evolved with two different scenarios
involving the way forward with the goal of
Contracting
private labs on a credible cost effective basis.
Improving the
capability and capacity of hospital based labs.
CEs to provide
update in July
What part, if any, did Dr Bierre
play in shaping the Northern Health Boards views about the future of
pathology in the region before he became inactive? Has the
Auditor General done a report on this matter? If so could this
please be released.
------------
05 / 09 / 06 - You can read our media
release for the rally by
clicking here. To collect 100,000 signatures is a remarkable
achievement and shows just how strongly the public feels about this
issue. This is a historic moment in Auckland health. We
have never seen a public reaction on this scale about a regional
health issue.
I look forward to
seeing you all at the rally this Thursday to present the petition.
------------
02 / 09 / 06 - Latest news! Another
rally this Thursday 7th September 8:30am outside Auckland Hospital.
The petition, which
last I checked was signed by over 90,000 people, (including those
who've signed online), will be presented to the district health
boards. See you there.
I have organized a
meeting for Monday with a North Shore MP to raise our concerns, stay
tuned for how that goes.
Updates to the website
include the introduction of a hit counter. I have started it off
using last months figures. Now you can all see at a glance how
many eyeballs we're clocking.
------------
28 / 08 / 06 - I am still astonished
after reading this article (click
here) by Nick Smith in the Listener entitled "Testing Times".
The comments coming from Dr Bierre and Gary Smith I find scary:
"“I know the
GPs are saying we won’t do it,” says Smith, “but I would be keen for
you to remind us all that we are actually here for the patients.”
Has Garry Smith taken
the
Hippocratic oath like the doctors have? I would suggest
given the current environment no GP would be here but for the
patients. What, one wonders, is Gary Smith here for?
Both he and Bierre
are scornful of any risk posed by the flight of pathologists overseas.
“They’ve nowhere to go,” says Bierre. “They try to manipulate the
whole process to their ends, they threaten to resign and they go home
and the wife says, ‘I’m not going, I’m not leaving.’"
Is the health of
Auckland dependant on the goodwill of GPs and pathologists' wives?
(Isn't that a bit sexist? Husbands too!)
If this is indicative
of the esteem Dr Bierre has for Pathologists then I fear he will have
great difficulty recruiting anyone but the most desperate. I
would find it difficult to accept working for someone who thought of
me or my professional colleagues that way.
------------
25 / 08 / 06 - Hurrah! This is more
like the reporting of the rally that it deserved. Check this
out: "Thousands
march for Medlab". I have no real idea how many people were
there but it was sure more than 500 that some media reported.
One posting on the forum claiming to have talked to the police said it
was a few thousand. I rang the Auckland Police to check this
fact but could not get an answer.
I made some enquries
and managed to find a transcript of the questions posed in Parliament
about the contract. Click here
to read the full transcript.
------------
23 / 08 / 06 - The releases from
Labtest suggest they have had a great response to their advertisements
and people are positively falling over themselves to be working with
them. The word from industry is totally different. Someone
is telling porkies. I don't know who to believe.
------------
19 / 08 / 06 - Awesome march. It
made a powerful statement. Most important was the diversity of
people there: Jo Public, GPs, Pathologists, Greens, Union members and
officials, of course Diagnostic Medlab Staff. I believe there
was at least 500 people there, if not a thousand. The
Auckland community will not let it's world class pathology be ruined
by a DHB determined to take crazy risks to cut costs.
To paraphrase Keith
Locke - they must not choose dollars over sense.
Great media turnout, I
spotted a couple of big cameras and spoke to several reporters from
major news agencies. NewsTalk ZB's article can be found online
already
click here. Audio reports
click here.
------------
17 / 08 / 06 - Another day with
some significant developments
Development one Green
MPs for Auckland, Sue Bradford and Keith Locke have joined the calls
for an urgent review. A brief quote from the release you must
read:
“We also
have reservations about the fact that Labtests is partly owned by Dr
Tony Bierre, who was a member of the Auckland DHB and played a key
role during early discussions about the restructuring of lab services,
actually making a presentation on the issue to the Northern DHBs
Coordinating Committee,” Ms Bradford says.
“The three Auckland DHBs are taking a huge risk by opting for dollars
over sense,” Mr Locke says.
“Medical professionals and the people of Auckland should not be used
as guinea pigs in a cost-cutting exercise which risks enormous
systemic failure by mid next year.
“We call on the three Auckland DHBs to reconsider their decision, and
on the Minister of Health to take a close look at what is really going
on here before it is too late,” Mr Locke says.
I support their calls
for the Minister of Health to examine what is going on here. See
you on Saturday Green Party!
Development two I have
received a communication claiming that the Auckland region Pathologists met last night and have signed a
letter, sent to the Government, stating they are
unwilling and have no intention to work with the new provider. This is serious.
Australasia is already short of pathologists,
this
article published by Royal College of Pathologists Australasia has
a compelling discussion about the serious shortage of pathologists
and lack of trainees coming through the system.
This decision may
result in an exodus of younger pathologists from Auckland and the
retirement of those advanced in their career. There is a real
possibility that there will not be a pathology workforce this time
next year large enough to cope with the workload.
Pathologists are the
single most crucial element of this whole debate. Without their
expert eyes examining our samples we are at serious risk. Does
anyone remember what happened in Gisborne?
If the Auckland
District Health Boards and Labtests Auckland cannot reach an agreement
with the pathologists in the region to support the new provider they
risk a real disaster. If they were responsible they would
have consulted with, and got the support of, the pathologists before
awarding the contract to a new provider.
Development three
Greypower have joined the protest and
challenge the
lab change too. This, like the Greens announcement, is
important news. It is an issue which the members of Greypower
have a significant stake in and it is wonderful to see they have
examined the situation and declared heir position. See you
on Saturday Grey Power!
------------
16 / 08 / 06 - Well a week has passed
and there have been some fantastic developments. The rally is
going ahead, and there has been some serious action in the papers,
with a letter to the editor from the CEOs of the DHBs and several
releases telling us all to move on.
The DHBs will not shut
this issue down by going deaf and telling us to move on. Our
health is at stake here and there is widespread concern about this
issue.
We're moving on
alright, moving en masse. This Saturday is an opportunity for
the Auckland Public and medical industry to get out and stretch their
legs marching up Queen St, while telling the DHBs in no uncertain
terms what we think of this decision.
Be there at QE2 Square
- 1:45pm!
------------
09 / 08 / 06 - Great news today, Diagnostic Medlab has
taken legal action in the high court over the awarding of the
laboratory services contract. Finally they are taking some
serious action. We shall see what comes of this action over the
next few weeks. This decision deserves at least a judicial
review.
The latest whispers are
that the march will be Saturday 19th of August. I hope to see
you all there. Firm details will be announced once released.
------------
08 / 08 / 06 - I have just googled and found the ADHB
release sent out through
Scoop
on the 4th of August.
Here is
classic spin: "ADHB Board chair Wayne Brown says Dr Bierre
went beyond the statutory requirements in standing down from all board
business six months prior to the community laboratory RFP and was not
privy to any information or participated in any discussion or
decisions regarding the tender."
They protest their
innocence too much. Dr Bierre might not have been privy
to information once the RFP was released and contract put out to tender,
but he was on the board while the RFP was being created!
Questions need to be asked about this.
Should an elected
member of a public board, representing us, be allowed to tender for a
contract awarded by the board? Isn't it an amazing coincidence.
Ps. Did you notice the
word "robust" in this release too? I did!
------------
06 / 08 / 06 -Labtests Auckland have released a
progress update. No details, more reassurances. I
challenge Labtests Auckland to be more forthcoming with the details.
Anyone can give reassurances. Where are the details?
"It is
still early days but Labtests is moving quickly to put into action its
advance planning so that people can start to see for themselves how we
will operate and the high standards we intend to impose." -
Progress Update
It is still early days? They have
less than 11 months now to setup an extensive testing network and
laboratory.
Advance planning? How advance was their
planning? I wonder if it was advanced before Dr Bierre stood
down from an active position on the DHB?
"High standards we intend to impose."
I ask exactly what standards they intend to impose on the Auckland
public. Are they the same standards of service we have come to
expect? Where is the detail?
------------
04 / 08 / 06 - I have heard rumors that there will be a
rally soon. Stay tuned for details. Get all your
friends ready for a rally Saturday 19th in Central Auckland.
Dr Bierre has
resigned from the Auckland District Health Board. How
convenient. According to the Herald article he was elected in
2004. Now that Labtests Auckland has the contract for community laboratory testing he must be too busy to hold this public office position.
Is this the only reason
why he was a member of the Auckland DHB?
There needs to be serious inquiry into
what role he played in the formation of the RFP for this contract, and
what knowledge he might have had when pitching his tender.
Something smells very funny here.
------------
01 / 08 / 06 - News of the day is a rumour posted on the
forum:
"Sherralynne:
I've heard a rumour that Labtest are offering a
very low pay rate to phlebotomists, around the level of our brand new,
in-training, pay rate."
We are seeking verification of this
rumour. If you can substantiate Sherralynne's post please
contact us here.
------------
27 / 7 / 06 - Three developments
today, the report on
Close
Up TV1 at 7pm (click
here to watch), which asked some difficult questions that I felt
were poorly answered. The word "robust" was used three times, is
it starting to sound like a broken record to you too?
If the plan is so
"robust" why not confidently reveal it to us all? Little detail
is being drip fed and at times it has been contrary (see below entry
25/07/06 10pm).
The most relevant point
made in this interview was that right now they don't have any
people. If the Diagnostic Medlab staff stick with the
company and back their team, Labtest will have real difficulty in
delivering on their milestone obligations, one of which surely would
be recruitment. Stay strong and hang in there - the
public is supporting you.
Second development -
the pathologists letter read out at the end of the
Close
Up report. I wish I had taped it to listen to it again but
the gist of what heard appeared to suggest they were quite happy where
they were and would not be seeking employment elsewhere. No
pathologists = no laboratory. Simple as that. If
anyone can quote exactly what was in that letter please email me and
I'll publish it because it could prove crucial.
If Labtest are going to
have to import an entire staff of pathologists they have a monumental
task on their hands. Good luck Labtest!
Third development - the
strong words coming out of DML. This I missed yesterday but it
has answered some questions (at least someone has!) - they are not
going to roll over and play dead. Two points of interest:
DML is one of the
most efficient of all Sonic’s laboratories
Sonic’s Ellerslie
laboratory is not available to Labtests
Looking at the release
appears DML bid approximately $5m below their current contract.
The DHB are saying it is a $15m pa saving, therefore Labtest must have
bid approximately $10m below this, based on the rough figures made
public to date.
If DML is one of the
most efficient labs in the Sonic Group, how exactly are Labtest going
to top that by $10m a year? I really want to know how. So
far we've had reduced collection centres, longer turn-around times
(depending on which release you read) and on-site testing. Is
this all? I wonder. What other "savings" have they got in
store?
By making their Lab
unavailable to Labtest, Sonic are really laying down the challenge.
On the news tonight the figures were a bit confused between $80m and
$18m that Labtest had set aside for setup costs, but needless to say,
if they do have to find a lab and set it up. This will be a
tremendous undertaking in 12 months, especially if they are also
having to setup collection centres and hire 300 staff.
Having just won the
contract, and with this great task ahead of them, you really have to
wonder about their ability to deliver when the CEO is on holiday in
Fiji.
------------
25 / 7 / 06 -10pm- Thanks to Dee for posting
a link to a Labtest's
Notice to Patients
In this
letter, I quote that Labtest Auckland says:
In the NZ Herald's article
$560m laboratory contract will halve number of blood-test clinics, Dr Bierre is reported : "He said one
area in which Labtests Auckland could make savings was in lengthening
the turn-around times of non-urgent tests, which were sometimes done
more quickly than necessary."
"We are writing to reassure you about
the improved laboratory services we will be providing to the
communities covered by the three District Health Boards in the
Auckland region, from July 2007."
I don't see anywhere in this letter where
they quantify this statement. I challenge Labtest to publish
their plans for improving the laboratory services currently
offered in Auckland. So far as I'm concerned, Diagnostic Medlab
have been providing a superb service, and if Labtest think they are
going to improve on it I am really keen to know how.
Show us your plans Labtest!
They have also said in this letter:
"The contract
Labtests Auckland has signed with the DHBs is detailed and
prescriptive."
"Under
the confidential contract, Labtests Auckland has signalled its
willingness to institute a more open and transparent cost structure
with the ARDHBs to help them make their health budgets go further in
addressing community needs."
I challenge Labtest to institute a more
open and transparent cost structure with the public and publish the
contract. What other changes are in store? Lets all
see the detailed and prescriptive arrangement and judge for ourselves
whether we believe they are up to the challenge.
------------
25 / 7 / 06 -6pm- Introducing the Campaigner of the Week
- Bruce
You can get your "I trust
Diagnostic Medlab!" t-shirt at Logoland in St Lukes Mall near
Whitcoulls. Contact me if you are
interested to purchase one. I would suggest we add
dontriskourhealth.com
underneath.
------------
24 / 7 / 06 - Well I got a nice surprise
this morning to open the NZ Herald and find that Mr Rudman appears to
have really taken a liking to me.
Click here to read his article. He is truly skilled in the
art of flaming.
I have sent a letter to the Editor of
the NZ Herald (click here) replying to Mr Rudman. He has now
taken two swipes at me, I think it's only reasonable the Herald afford
me the
opportunity to state my case and defend this website.
------------
22 / 7 / 06 - *Newsflash*
- get
your "I trust Diagnostic Medlab!" T-shirt from Logoland in St Lukes
Mall next to Whitcoulls. What a great idea. Big ups to
whoever got that t-shirt patter made up and printed!
------------
22 / 7 / 06 - Thank you everyone, the
response has been totally overwhelming. I felt passionately
about this issue, but it has really blown me away to see how many of
you care deeply about this too.
In the last 24 hours I've spoken to one
reporter, been
bagged by Rudman, and received a flood of messages
supporting the petition. All in all this is an encouraging
start!
To all the supporters of this petition:
We have to get the word out there and raise awareness.
This petition is about urging the DHB to
consult with the public, and reconsider their decision. We are
encouraging them to make a decision in line with public values, and
not take unnecessary risks with our health.
Cheaper is not always better and anyone
can put costings on paper. DML knows from experience what it costs to
run community laboratory services in this area. Surely if DML
are saying it's not feasible to run it that cheaply we should take
notice. They are the experts with the experience.
------------
21 / 7 / 06 - Well its launched!
Finally at 3 o'clock yesterday morning I managed to get the basic
website finished and integrate the tag board. I've never
undertaken a website like this but it's amazing the energy you find to
put into something when you're really passionate about it.
This is a campaign I
have launched of my own accord and volition because I'm fed up with
elected and appointed public servant bureaucrats making decisions, on
behalf of their constituency, without genuine
consultation. This time it has really hit home: they don't
care what we think. Their primary concern
was cost, not my welfare.
That is very very scary.
During my lifetime,
when required, Diagnostic and Medlab, and then DML, have provided an
outstanding service of the highest calibre. The DHBs have made a truly awesome decision on our behalf without even
asking us what we think.
Ballsy and brave or
arrogant and short sighted? You decide.
