The costs of our health system
There is to be a radical change in the way health services are delivered in New Zealand. All 20 District Health Boards (DHBS) in New Zealand are to be abolished and replaced by a single national organisation called Health New Zealand. Health New Zealand will have four regional divisions.
A new Ma¯ori Health Authority will be established. A further new Public Health Authority will be created. The Ministry of Health will be strengthened and willmonitor performance and advise government.
Essentially, we are moving from a decentralised model to a very centralised one.
Overall, two things are certain. First, the changewill cost a very large amount of money. Secondly, there will be significant employment consequences. It seems safe to assume that the leadership and support structure in the 20 DHBS will be stripped out. People will lose their jobs. Most should be re-employed in the four regional centres or one of the new national organisations such as Health New Zealand, but many will obviously miss out.
It will be interesting to see whether those currently employed will be given preference over new people when the new bodies are looking for staff. The usual employment law wouldmean the new bodies, as different employers to the DHBS, would not be obliged to take on existing staff.
Further, the shrinking pool of employers for medical professionals would increase the impact of a serious misconduct process involving a doctor, for example. Many of these processes end in an agreed departure, including confidentiality terms. These enable the parties to move on without litigation to decide the merits of the allegations and dismissal.
A doctor might move from one DHB to another, confident that the former employer cannot disclose what was alleged. With a centralised employer, many medical professionals will have fewer alternatives.
A similar problem is arising for career public servants in general. The Public Service Commission recently released new guidelines for recruitment practices. The new policy applies tomany governmental organisations.
The new guidelines suggest recruiting bodies ask applicants whether they have been subject to a serious misconduct investigation.
At the application stage, a prospective employee is asked to consent to a serious misconduct disclosure from their previous employer. If they do not consent to a serious misconduct disclosure, this does not mean they cannot be employed. But realistically it is not easy to believe that such a person is likely to be employed.
Employing managers are asked to decide on a case-by-case basis. How recent any integrity or conduct issue occurred is a consideration. So is any counselling, retraining or rehabilitation the person has undergone. Finally, the explanation by the candidate is also relevant. Generally, the inquiry goes back only three years, but for senior or high-risk roles the inquiry may go back further.
The commission has suggested that government employers think carefully whether to include confidentiality terms when settling matters. They are encouraged to consider in settlement discussions what the parties can agree to say if consent is sought for disclosure further down the track.
Many candidates will be surprised to hear about these new guidelines. People want the opportunity to put their mistakes behind them and move on with their lives.
On the other hand, the Public Service Commission will say that it does not want to see people moving from one government agency to another when serious integrity issues have not been disclosed. Given the importance of public trust and confidence in the public sector, the new employer should know about these things.
New Zealanders take pride in the integrity of our government organisations and the integrity of their staff. Kiwis also would want to treat applicants for jobs fairly. The Criminal Records (Clean Slate) Act 2004 is an example of this generous spirit. It applies to minor offences and a person relying on it must have had no convictions within the past seven years.
The new public service policy on past employment searching into candidates for new roles is less generous. Any workers losing their old jobs through the health reforms will likely be casualties if they have a serious misconduct conviction lurking in their recent past.
– Peter Cullen was the founding partner of Cullen – the Employment Law Firm. He can be contacted at peter@cullenlaw.co.nz.