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The honeymoon appears well and truly over between the senior doctors' union and Health Minister Tony Ryall.
In a paper to an Australian Medical Association meeting in Canberra this week, Association of Salaried Medical Specialists (ASMS) executive director Ian Powell delivered a stinging critique.
Mr Powell said Mr Ryall had a "highly personalised" style, running the portfolio with his own "inner circles". These "insiders" were now reporting a tougher attitude.
"Instead of being asked by [Mr Ryall] what they know about or think about particular issues, it is now notification of what he intends to do.
"One of the dilemmas is the influence on the minister of those who look to quick fixes ... when longer-term solutions are required if the fix is to be sustainable."
As a new minister, Mr Ryall made some well-received changes, such as establishing the National Health Board within the Ministry of Health, the paper said.
But his relationship with doctors had deteriorated. He had a vocal and hostile reception at the ASMS annual conference in November, the paper said.
"He did not leave the conference a happy minister".
Frustrations included the "denial" of the medical specialist shortage, failure to award doctors greater leadership roles, and increased demands on health services, with smaller funding increases.
A plan to save $700 million over five years through savings in DHB back-office functions was in areas such as banking and insurance.
However, he feared a tendency of the Government's Health Benefits Ltd to over-simplify the health system, and try to do away with essential staff such as cleaners, clerical workers, boilermakers and orderlies.
He also criticised a proposed amalgamation of regulatory bodies, and a proposed public-private partnership to rebuild health services in Christchurch.
Mr Powell linked Mr Ryall's change of tack with the Government's "hard line" shift since the general election, but his ire is not limited to National.
"Both main political parties - National and Labour - are in a race to see who can best lose the next election."
"It is a race between whether National can antagonise and aggravate its way to defeat, or whether Labour can sleep-walk to defeat."
When contacted, Mr Ryall dismissed Mr Powell's comments as union posturing.
"I have positive and constructive relationships with clinicians all around the country.
"Every week, I talk with clinicians and staff at the front line, who are not reluctant to let me know their views.
"However, my relationship with union heads is different, as they are more often focused on making political statements."