Advice holds to Gibbs line

Press, 23 October 1989, Page 2

Advice holds to Gibbs line

By

PATTRICK SMELLIE

in Wellington

Government health policy is edging closer to parts of the controversial Gibbs Hospital Task Force report, after endorsement yesterday of performance-based contracts for public hospital doctors.

“Widespread adoption of contracts for medical officers would be a significant step towards a health system which is more focused on outputs,” the Minister of Health, Ms Clark, said. She was releasing a report by the Advisory Committee on the Medical Workforce on contracts for medical officers employed by area health or hospital boards.

Improved health status, quality care and consumer satisfaction could become criteria for assessing performance, rather than inputs, such as the number of beds used, staff employed, and money spent, Ms Clark said. While the report stems from work begun at the same time the Gibbs task force was under way last year, it does not claim any influence from that report. But the conclusion is closely in line with recommendations in the Gibbs report, which the then Minister of Health, Mr Caygill, distanced himself from.

“The relatively unproductive performance of some doctors in public hospitals, compared to their performance in private hospitals, has a lot to do with the lack of financial incentives and the less personalised doctorpatient relationships,” the Gibbs report found. “Without clear contractual obligations in the public sector, and because they have personal commitments to patients in the private sector which they cannot or do not wish to change at short notice, their time in the public sector becomes less effective,” it

said. Ms Clark acknowledged the Gibbs claim that private-sector health care contained more incentives to be productive. “If the roles and responsibilities of area health board general managers and contracted medical practitioners can be clearly specified through a contract system, this should help provide a much-needed basis for performance appraisal and remuneration,” she said. It should also provide more flexibility in deployment of the medical workforce, and improve public-health sector efficiency. “A system of contract employment could not be introduced overnight,” said Ms Clark. She urged area health boards to study the report for “early action.”

The report outlined two types of contract, drawing a distinction between contracts of service and contracts for service. Contracts of service laid down a basis for employment, with reference to relevant labour legislation and award rates of pay and conditions. Contracts for service dealt with the kinds of services required and payment to be made on delivery of those services. This kind of contract did not set up a formal employment relationship between the parties involved. It would be this kind of contract which could be used more to relate pay to performance of specified tasks to agreed standards.