Doctors' expenses queried

John Pine
John Pine
Improved accountability for millions of dollars spent on district health board senior doctors' continuing education is being sought by Audit New Zealand.

In its audit report for the Southern District Health Board for last financial year, released under the Official Information Act, Audit NZ noted the board was aware of its deficiency in guidance on what constituted ''actual and reasonable'' continuing medical education (CME) expenses.

Last financial year, the board spent $3,049,419 on the expenses and it has spent $2,688,802 in the nine months to March this year.

The CME clause in the senior doctors' collective agreement allows for up to 10 days' leave for continuing education, plus travel time and reimbursement of actual and reasonable expenses up to $16,000 a year (able to be accumulated for three years).

Audit NZ said it did not regard this entitlement as straight remuneration to be taken at the discretion of the employee, as some boards had suggested.

As with other types of sensitive expenditure, it was prudent to have a policy on what would be regarded as actual and reasonable expenses, including such things as classes of travel, price of meals and purchase of alcohol.

Also, there needed to be some guidance on what qualified as continuing education and what did not.

The board, in its response agreed with the Audit New Zealand view, saying it had a policy drafted which was awaiting management approval.

Board executive director of human resources John Pine, in an emailed response to questions, said the board was still in the process of finalising the guidelines.

Generally, what were acceptable activities and what was actual and reasonable were well understood.

Senior doctors were required to specify the relevance of the activity to their medical specialty, the number of days' leave required and an estimate of the expenses as part of the process.

Applications were dealt with on a case by case basis, ''within appropriate delegations''.

The former Otago and Southland boards had different approval processes and delegations and some differences in what had historically been approved.

For this reason, there was a need to develop a single set of guidelines for the Southern Health Board.

Draft guidelines had been available since 2011, but ''we held off finalising them until the district leadership structures were in place''.

The guidelines had been used as the basis for other South Island boards, with the aim of ensuring some consistency.

The Canterbury board had been consulting the Association of Salaried Medical Specialists (ASMS) on behalf of the other boards.

Mr Pine said the Southern District Health Board had recently discussed the guidelines with ASMS and noted comments on points of difference from the Canterbury document.

A draft would shortly be submitted to the executive for consideration of the differences and eventual approval.

ASMS executive director Ian Powell said the issues involved were mainly to do with inconsistencies in application across the services in a large organisation.


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