- Email: [email protected]
Additional comments to Richard Price on radiographer reporting in New Zealand
Radiography (2007) 13, 83e84
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
LETTER TO THE EDITOR
Additional comments to Richard Price on radiographer reporting in New Zealand Dear Editor in Chief, Richard Price1 gives a good summary of the fundamental principles of the funding of healthcare provision in New Zealand. However, there are places in New Zealand that suffer shortages of radiologists and radiographers that may be in the larger cities but often also in the smaller to medium sized centres and particularly those that are essentially rural providers. The funding arrangements have, without doubt, led to a suppression of the usefulness of the role of radiographer reporting. The most frequent excuse given against the adoption of this advanced role is by the medical profession who indicate they have concerns regarding skill levels and likely litigious potential from clients of the service, a common perspective of the mid1990s in the UK. Indeed, the nursing profession finds itself battling to role develop and defending against medical inferences that the adoption of practices (that we have seen in the UK for many years and have been supported by appropriate research) as being unsafe. Brian Tidey2 in his comments to the August 2005 edition of Radiography also outlines the limited use of the reporting radiographer from his experience in a medium sized centre. While this may be true in the part of New Zealand he resides and works there are examples of cases, particularly in the Auckland conurbation and to some extent in other large centres, where the public sector is unable to cope with its workload. Press releases centre round a shortage of radiologists and radiographers. It is an interesting observation that, and this has been noted in the South Island too, the public sector is struggling to provide its service in a timely fashion even in larger centres and work is sub-contracted out to the local private practices from the public purse. This is doubly concerning whereby radiologists are permitted, as in England, to have private practice time when waiting lists are being created in the public sector. One suspects a potential for the tax payer having to pay twice for a service that could have been delivered, with the correct investment, in the public sector. One also gets the impression that a similar situation is developing
here compared with that noted in the NHS about 10 years ago following recent reports that indicate the medical profession is concerned that its working conditions expect duty times in excess of 72 h per week.3 Tidey2 also indicates that the population is small and so the demand is not the same. I would agree with him at face value, however, the same demographic problems, whilst not having bitten to the same degree as they have in the UK are looming in New Zealand. These demographic trends are likely to be felt more deeply as a result of: The retirement of the baby boomers of New Zealand which is about to begin in earnest. A compounding effect as larger numbers of immigrants, who bring their skills with them, come to New Zealand and in many instances wish to have their extended families with them so causing a greater burden on the healthcare system. Indeed, the issue of the overall small population means that when the effects above are felt they are likely to be felt more deeply than in the UK when one considers the numbers equation. Currently, healthcare insurers have not begun raising premiums to the unaffordable heights we may have seen for elderly populations elsewhere, which will, by virtue of cost preclude many older New Zealanders from private healthcare. Indeed one of the major worries here, as in the UK, is the burgeoning superannuation and healthcare bill facing the government amongst a country of poor savers that will result in an aging population burden in more ways than health and social care costs. Population numbers and proportions contributing to the tax burden will be reduced and because extended lifespan means health services will have to be available longer and for more people, price increases through the private providers will be inevitable from a smaller taxation pool. Who wins in this situation? Tidey2 talks about major centres being the places where radiographer reporting would be seen as a potentially useful role. I believe this service could also be highly valuable in many of the smaller centres in the more rural parts of the
1078-8174/$ - see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2005.11.005
84 country that do not have full time radiology cover or good teleconferencing links through which to move images for reporting. Indeed, even if images were moved electronically there are not always staff available to comment on them in a timely way that would be an expected right of the service user. There is also a need to be able to attract personnel to these centres to provide a basic service as they are not perceived as being as high flying as others and so suffer from radiography staff recruitment problems. Indeed, as in Britain, the Medical Radiation Technologists Board (MRTB is the HPC equivalent) has expressed concern about recruitment levels and is currently in talks with tertiary education providers regarding the development of return to practice options that would fit with current registration legislature in New Zealand. There are many radiographers who work single handedly or part time as a small team who could provide a reporting service immediately for their patients. A caveat does present here though which Tidey rightly outlines and that is overall workload for skills maintenance, however, as in the UK not all will want to participate in this way thus ensuring available workloads are sufficient for skills retention. It may even be more feasible to develop a national image bank for New Zealand against which to test personnel with advanced roles. If I remember correctly this option was in development, or at least being considered, when I came to New Zealand from the UK but was struggling due to size of task, concerns over content and who should be tested by this tool. There is also a need to consider retention of staff. New Zealanders by nature like to explore the big wide world. They are travelling and seeing these developments and asking why is this not the case back home? They are also seeing that the efforts of their degree education can be better rewarded and so rather than having their overseas experience for a year or two they are tending towards staying abroad where they earn more, are respected more by the multidisciplinary team and get greater job satisfaction. While these practice limitations are enforced, the issue at stake is why is education at degree level? The New Zealand economy sees itself as being a contributor to the education economy of the future and only perceives itself as surviving as a nation to be reckoned with if it adopts this policy. What a waste if it is not used to its fullest extent. Recruitment and retention of the graduate are a concern for the government and indeed they have responded by making changes to student loans that should attract back or keep the degree educated practitioner. There are also issues in the way the District Health Boards (regional providers of public healthcare) are funded to provide services, which begin to raise the questions that were being asked in the UK regarding costs and appropriateness of certain personnel performing certain tasks. With this in mind, opportunities for New Zealanders who do stay at home should be explored. The nursing profession appears to have more status here than the medical radiation technologist (radiographer), again very like the position the UK profession found itself in around the mid-1990s if not before. Even though I said earlier nursing is doing battle with the medical profession it is winning by sheer numbers and loudness of voice, it too drawing on UK and even US experiences. This in turn raises the spectra of boundary blurring but in the wrong way as
Letter to the Editor has been experienced in UK practice. However, work is underway through the New Zealand Institute of Medical Radiation Technologists to identify and establish where the radiographer could be used to greater effect so the technician, button pushing face will be reduced and the profession allowed to move forward. I would say that currently the New Zealand medical imaging service is at the cross-roads UK radiographers found themselves at about 10e15 years ago. I believe this is a good time to explore the opportunities that were seen to develop in the UK and to learn from mistakes that were made. Indeed, the newly qualified and post-registered radiographers from New Zealand are receiving the kind of education that permits smooth integration into the current UK market as they are encouraged to explore an understanding of role developments in their degrees. Radiographers have much to offer, however, the medical power position about which much has been written over the years still has a strong grip here and the way services are provided needs to be looked at. Brian Tidey’s work (and any other pioneering New Zealand reporting radiographers) should be applauded and supported as it may act as a catalyst for a move towards role development in New Zealand to address the above concerns. The Blair years of government, following on from the early ideas of the Major administration of the mid-1990s, has taken the NHS a long way. At first it looked decidedly unstable but it would appear to now be moving in an appropriate direction. Perhaps Helen Clarke in her newly elected minority coalition government needs to take on board some of the ideas of the UK for the benefit of all healthcare service delivery in New Zealand. Yours sincerely
References 1. Price RC. Response to letter to the editor by Brian Tidey. Radiography 2005;11(4):305e6 [Elsevier, UK]. 2. Tidey B. Letters to the editor. Radiography 2005;11(3):226. 3. Study says young doctors lack sleep. One News (Television broadcast). Transcript Retrieved November 10, 2005 from: http://www.tvnz.co.nz/view/page/411319/625883.
Jonathan McConnell Christchurch Polytechnic Institute of Technology, School of Applied Science, PO Box 540, Christchurch 8015, New Zealand Tel.: C64 3 940 8736; fax: C64 3 366 6544. E-mail address: [email protected] Available online 7 February 2006
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
LETTER TO THE EDITOR
Additional comments to Richard Price on radiographer reporting in New Zealand Dear Editor in Chief, Richard Price1 gives a good summary of the fundamental principles of the funding of healthcare provision in New Zealand. However, there are places in New Zealand that suffer shortages of radiologists and radiographers that may be in the larger cities but often also in the smaller to medium sized centres and particularly those that are essentially rural providers. The funding arrangements have, without doubt, led to a suppression of the usefulness of the role of radiographer reporting. The most frequent excuse given against the adoption of this advanced role is by the medical profession who indicate they have concerns regarding skill levels and likely litigious potential from clients of the service, a common perspective of the mid1990s in the UK. Indeed, the nursing profession finds itself battling to role develop and defending against medical inferences that the adoption of practices (that we have seen in the UK for many years and have been supported by appropriate research) as being unsafe. Brian Tidey2 in his comments to the August 2005 edition of Radiography also outlines the limited use of the reporting radiographer from his experience in a medium sized centre. While this may be true in the part of New Zealand he resides and works there are examples of cases, particularly in the Auckland conurbation and to some extent in other large centres, where the public sector is unable to cope with its workload. Press releases centre round a shortage of radiologists and radiographers. It is an interesting observation that, and this has been noted in the South Island too, the public sector is struggling to provide its service in a timely fashion even in larger centres and work is sub-contracted out to the local private practices from the public purse. This is doubly concerning whereby radiologists are permitted, as in England, to have private practice time when waiting lists are being created in the public sector. One suspects a potential for the tax payer having to pay twice for a service that could have been delivered, with the correct investment, in the public sector. One also gets the impression that a similar situation is developing
here compared with that noted in the NHS about 10 years ago following recent reports that indicate the medical profession is concerned that its working conditions expect duty times in excess of 72 h per week.3 Tidey2 also indicates that the population is small and so the demand is not the same. I would agree with him at face value, however, the same demographic problems, whilst not having bitten to the same degree as they have in the UK are looming in New Zealand. These demographic trends are likely to be felt more deeply as a result of: The retirement of the baby boomers of New Zealand which is about to begin in earnest. A compounding effect as larger numbers of immigrants, who bring their skills with them, come to New Zealand and in many instances wish to have their extended families with them so causing a greater burden on the healthcare system. Indeed, the issue of the overall small population means that when the effects above are felt they are likely to be felt more deeply than in the UK when one considers the numbers equation. Currently, healthcare insurers have not begun raising premiums to the unaffordable heights we may have seen for elderly populations elsewhere, which will, by virtue of cost preclude many older New Zealanders from private healthcare. Indeed one of the major worries here, as in the UK, is the burgeoning superannuation and healthcare bill facing the government amongst a country of poor savers that will result in an aging population burden in more ways than health and social care costs. Population numbers and proportions contributing to the tax burden will be reduced and because extended lifespan means health services will have to be available longer and for more people, price increases through the private providers will be inevitable from a smaller taxation pool. Who wins in this situation? Tidey2 talks about major centres being the places where radiographer reporting would be seen as a potentially useful role. I believe this service could also be highly valuable in many of the smaller centres in the more rural parts of the
1078-8174/$ - see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2005.11.005
84 country that do not have full time radiology cover or good teleconferencing links through which to move images for reporting. Indeed, even if images were moved electronically there are not always staff available to comment on them in a timely way that would be an expected right of the service user. There is also a need to be able to attract personnel to these centres to provide a basic service as they are not perceived as being as high flying as others and so suffer from radiography staff recruitment problems. Indeed, as in Britain, the Medical Radiation Technologists Board (MRTB is the HPC equivalent) has expressed concern about recruitment levels and is currently in talks with tertiary education providers regarding the development of return to practice options that would fit with current registration legislature in New Zealand. There are many radiographers who work single handedly or part time as a small team who could provide a reporting service immediately for their patients. A caveat does present here though which Tidey rightly outlines and that is overall workload for skills maintenance, however, as in the UK not all will want to participate in this way thus ensuring available workloads are sufficient for skills retention. It may even be more feasible to develop a national image bank for New Zealand against which to test personnel with advanced roles. If I remember correctly this option was in development, or at least being considered, when I came to New Zealand from the UK but was struggling due to size of task, concerns over content and who should be tested by this tool. There is also a need to consider retention of staff. New Zealanders by nature like to explore the big wide world. They are travelling and seeing these developments and asking why is this not the case back home? They are also seeing that the efforts of their degree education can be better rewarded and so rather than having their overseas experience for a year or two they are tending towards staying abroad where they earn more, are respected more by the multidisciplinary team and get greater job satisfaction. While these practice limitations are enforced, the issue at stake is why is education at degree level? The New Zealand economy sees itself as being a contributor to the education economy of the future and only perceives itself as surviving as a nation to be reckoned with if it adopts this policy. What a waste if it is not used to its fullest extent. Recruitment and retention of the graduate are a concern for the government and indeed they have responded by making changes to student loans that should attract back or keep the degree educated practitioner. There are also issues in the way the District Health Boards (regional providers of public healthcare) are funded to provide services, which begin to raise the questions that were being asked in the UK regarding costs and appropriateness of certain personnel performing certain tasks. With this in mind, opportunities for New Zealanders who do stay at home should be explored. The nursing profession appears to have more status here than the medical radiation technologist (radiographer), again very like the position the UK profession found itself in around the mid-1990s if not before. Even though I said earlier nursing is doing battle with the medical profession it is winning by sheer numbers and loudness of voice, it too drawing on UK and even US experiences. This in turn raises the spectra of boundary blurring but in the wrong way as
Letter to the Editor has been experienced in UK practice. However, work is underway through the New Zealand Institute of Medical Radiation Technologists to identify and establish where the radiographer could be used to greater effect so the technician, button pushing face will be reduced and the profession allowed to move forward. I would say that currently the New Zealand medical imaging service is at the cross-roads UK radiographers found themselves at about 10e15 years ago. I believe this is a good time to explore the opportunities that were seen to develop in the UK and to learn from mistakes that were made. Indeed, the newly qualified and post-registered radiographers from New Zealand are receiving the kind of education that permits smooth integration into the current UK market as they are encouraged to explore an understanding of role developments in their degrees. Radiographers have much to offer, however, the medical power position about which much has been written over the years still has a strong grip here and the way services are provided needs to be looked at. Brian Tidey’s work (and any other pioneering New Zealand reporting radiographers) should be applauded and supported as it may act as a catalyst for a move towards role development in New Zealand to address the above concerns. The Blair years of government, following on from the early ideas of the Major administration of the mid-1990s, has taken the NHS a long way. At first it looked decidedly unstable but it would appear to now be moving in an appropriate direction. Perhaps Helen Clarke in her newly elected minority coalition government needs to take on board some of the ideas of the UK for the benefit of all healthcare service delivery in New Zealand. Yours sincerely
References 1. Price RC. Response to letter to the editor by Brian Tidey. Radiography 2005;11(4):305e6 [Elsevier, UK]. 2. Tidey B. Letters to the editor. Radiography 2005;11(3):226. 3. Study says young doctors lack sleep. One News (Television broadcast). Transcript Retrieved November 10, 2005 from: http://www.tvnz.co.nz/view/page/411319/625883.
Jonathan McConnell Christchurch Polytechnic Institute of Technology, School of Applied Science, PO Box 540, Christchurch 8015, New Zealand Tel.: C64 3 940 8736; fax: C64 3 366 6544. E-mail address: [email protected] Available online 7 February 2006