Workforce Assessment Report DHB Medical Laboratory Workforce · Workforce Assessment Report ......

Prepared by Kamini Pather

Strategic Workforce Services

Strategic Workforce Services

Workforce Assessment Report DHB Medical Laboratory Workforce

June 2016

Strategic Workforce Services – DHB Medical Laboratory Workforce 1

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Table of Contents Executive Summary ............................................................................................................................ 3

Key Findings ........................................................................................................................................ 3

Recommendations .............................................................................................................................. 5

1. Purpose ......................................................................................................................................... 7

1.1 Background ................................................................................................................................. 7

1.2 Context ....................................................................................................................................... 8

2. Medical Laboratory Services in New Zealand ............................................................................... 9

2.1 The Medical Laboratory Workforce Defined .............................................................................. 9

2.2 Service Provision......................................................................................................................... 9

2.3 Medical laboratory service provision arrangements by DHB ................................................... 10

3. The DHB Medical Laboratory Workforce Overview ................................................................... 11

4. Current Status of the DHB Medical Laboratory Workforce ........................................................ 15

4.1 Overall Assessment of the Medical Laboratory Workforce ...................................................... 15

4.2 Rationale ................................................................................................................................... 14

4.3 Summary of the Current Status of the DHB Medical Laboratory Workforce ........................... 16

4.4 Workforce Assessment ............................................................................................................. 17

4.4.1 Service Demand .................................................................................................... 17

4.4.2 Supply ................................................................................................................... 20

4.4.3 Operational Flexibility ........................................................................................... 23

4.4.4 Operational Capacity ............................................................................................ 25

4.5 Medical Laboratory Workforce Engagement Groups ......................................................... 28

4.5.1 The National Pathology and Laboratory Round Table .......................................... 28

4.5.2 The National Laboratory and Engagement Group ................................................ 30

4.5.3 Canterbury Health Laboratories Annual User Group Meeting ............................. 30

4.5.4 Other Groups ........................................................................................................ 31

5. Operational Workforce Analysis ................................................................................................. 32

5.1 Regulatory Requirements for Medical Laboratory Workers in New Zealand .......................... 32

5.2 Changes to Registration Requirements from 01 February 2016 .............................................. 32

5.3 Workforce Description ............................................................................................................. 34

5.4 Key Service, Operational Workforce and Employment Drivers ................................................ 34

5.5 Service Delivery & Development Drivers.................................................................................. 34

5.6 Demographics ........................................................................................................................... 34

5.7 Current employed workforce ................................................................................................... 34

5.7.1 Recruitment .......................................................................................................... 34

5.7.2 Retention .............................................................................................................. 35

5.8 Training and Development ....................................................................................................... 35

5.8.1 Entry/ Transition Competency: ............................................................................. 35

5.8.2 Match to Service Requirements: .......................................................................... 35

5.8.3 Access to On-going Training (progression): .......................................................... 35

7. References .................................................................................................................................. 36


Executive Summary

Current analysis of the DHB medical laboratory workforce has resulted in it being classified

as a ‘Transitional Occupation’. Overall, the DHB medical laboratory workforce is in a state of

transition with considerable variance between DHBs, depending on regional service

provision arrangements, workforce size and geographic location. There are a few long

standing issues around recruiting for particular areas of specialisation and rural areas;

increasing service demand; the increasing impact of technology; the changing nature of

laboratory work; and the challenges of managing issues relating to the ageing workforce

demographic. While there are emerging requirements for more flexible workforce options

there is very limited substitution that can occur, due to the lack of available substitutes that

can perform the critical functions of this workforce. No significant priorities have been

identified for the DHBs to address through the bargaining strategy.

Key findings include:

Service demand is variable between DHBs, dependent on geographical location and

the populations they service. Overall service demand is progressively increasing due

to increasing and changing population demands, as well as the success of national

health programmes requiring medical laboratory tests; with peak demand pressures

on laboratory services such as histology. Service demand and provision is also

changing within the medical laboratory context.

While there is an overall stable supply pattern, there are some emerging distribution

issues and wider issues with supply. However, these are localised issues rather than

the entire workforce, i.e. with particular areas of specialisation, management roles

and certain geographic areas. The DHB medical laboratory workforce is changing in

distribution and composition. There is considerable variation in the supply patterns

being experienced by individual DHBs. This appears to be largely dependent on

geographic location. DHBs with large urban populations are experiencing sufficient

and in some cases an oversupply of medical laboratory workers, while other DHBs

with rural populations are facing supply challenges.

There are no significant workforce flexibility issues. This workforce comprises largely

technically specialised roles with specific qualifications and scopes of practice.

Hence, there is no flexibility in terms of scopes of practice, work and areas of

specialisation. There are some emerging requirements for more flexible workforce

options for the DHB medical laboratory workforce, however there is very limited

substitution that can occur. This is being addressed through multi-skilling staff,

flexible work arrangements to enable coverage and the use of enhanced

technological capability to increase flexibility in the way work is organised.


DHBs vary considerably in terms of operational capacity. Many DHBs are

experiencing no significant recruitment and retention issues, and there is generally

easy access to this workforce when required. However, internationally and

nationally, there are generalised recruitment and retention issues in areas of

specialisation and for leadership roles, with longer timeframes for gaining this

workforce. Additionally, DHBs with rural laboratories are experiencing difficulty

recruiting and retaining staff for rural locations. As a result some DHBs operational

environments are being affected by potential lack of this workforce, due to the

higher level of workforce specialisation required within the medical laboratory

context. The high numbers of retirements in this ageing workforce also impacts on

retention. Additionally, age related health issues can be complex to manage.

There are also issues sourcing people for management positions, i.e. with technical

skills and leadership / people management skills. This may be because this workforce

does not tend to move between laboratories due to the market being too small, and

some staff choosing not to work in the private sector. There are also MLWs of very

long tenure that are at the top of their scientific scales but do not want to lead into

their retirement years, and younger emerging staff may see the step to a leadership

role as too great. The remuneration gap between private and public sector labs for

scientific leadership positions is very large. Although private laboratories usually

have fewer leadership roles, as they do not have the mix or sub-specialisations of

DHB services, the private laboratories tend to remunerate their leadership roles at a

higher level than the DHBs.

New technology is having a significant impact on the role and increases the on the

job training required. Information technology, informatics, work flow process design,

etc. are now integral in the MLWs work environment.

The composition of the DHB medical laboratory workforce is also changing. The

proportions of scientists and technicians vary significantly between DHBs depending

on operating models and technological infrastructure. The needs of the workforce

are changing, so technical and scientific ratios are also likely to change.

There are some emerging needs for other scientist skills vs traditional medical

laboratory science skills. The ML workforce is moving from a total bench, hands on

scientists, to experts in process, automation and equipment, result interpretation,

complementary knowledge experts for referrers and patients, with specialisation in

managing laboratory information systems and bioinformatics.


Medical laboratory science, pathology, scientific and technological advances are

moving relatively quickly so it is anticipated that there will be a continuing need to

develop and transition the medical laboratory workforce to meet changing needs.

With increased use of automated technology, laboratory scalability to meet volumes

in high volume testing areas is achievable often without investment in additional

staff.

There are some predictions that the future medical laboratory workforce may

comprise fewer scientists and more technicians due to automation as well as cost

drivers, especially within the community environment. A tertiary level research

laboratory would have a slightly difference mix. Conversely, other predictions are

that increasing automation will reduce the number of technicians required and bring

a shift in the scientist role to be more consultative.

There are issues around the lack of training funds for specialised training and for

funded ‘Trainee’ positions. Funding of Continuing Professional Development (CPD) is

negotiated. Training is needed to develop specialist skills, however funding is an

issue. It can be difficult for smaller DHBs and laboratories to keep up skills

development and CPD. Additionally, the DHB environment has a number of older

staff who are unlikely to move and free up opportunities for younger MLWs. There is

also a tension between specialist vs generalist capability development. The drive

towards specialisation could create a shortage of generalists over the long term.

Recommendations

It is recommended that the following actions be considered in relation to the DHB medical

laboratory workforce:

Quantifying and monitoring increasing service demand to ensure optimal

understanding of the operating environment, and to support proactive management

of volume changes.

Comprehensive analysis of the increasing impact of technology changes and

automation on this workforce over the long term, to support future planning.

Further enquiry into the changing nature of laboratory work, such as the emerging

need for other scientist skills vs traditional medical laboratory science skills, to

ensure that the DHBs are able to be effectively responsive to any necessary

change/s.


Exploration of options to support long term capability development in management

/ leadership development and the areas of specialisation which are experiencing or

are likely to experience supply issues.

The DHBs review representation on the National Pathology and Laboratory Round

Table (the Round Table) to ensure effective participation, and to leverage

opportunities for addressing sector wide issues to enable a coordinated national

approach to workforce planning and development. The Round Table commenced

work in late 2015 on identifying changes in the laboratory industry and workforce

implications, as the first step to describing a blueprint to consider and plan for future

laboratory workforce requirements. This includes defining the current state for the

workforce, identifying changes in the industry, and considering the response

required to ensure the workforce is able to respond appropriately to change.

The NLEG consider narrowing its scope to focus only on addressing employment

related issues as required. With wider workforce issues to be addressed by

leveraging of the broader perspective offered by the Round Table’s workforce

development programme.

The DHBs retaining MLWs review DHB representation on the NLEG, to ensure

appropriate and proportionate representation. Somewhat proportionate

representation could occur by selecting representatives based on regional workforce

size.

Developing a long term strategy for managing the ageing workforce, in particular

managing the correlating complex age related health issues and planning for high

numbers of retirements.

Note that on 01 February 2016, the Medical Sciences Council made significant

changes to the registration requirements and scopes of practice for medical

laboratory science practitioners in New Zealand. These changes are likely to have

significant implications for the DHB medical laboratory workforce.


1. Purpose The purpose of this paper is to provide an overview of the current DHB medical laboratory

workforce and to recommend actions for the development of this workforce, based on the feedback

received from DHBs and the workforce information data.

Workforce development is a key enabler for DHBs and has a significant impact on service delivery

and DHB outcomes. Operational advice on the DHB employed workforce is developed by the

Strategic Workforce Services team and is complementary to the strategic advice and direction

provided by Health Workforce New Zealand (HWNZ) and the operational activity of associated lead

professional groups.

The operational workforce advice provides a view of the current status of the DHB Medical

Laboratory workforce. The recommendations from the report will be presented to the lead

operational groups for consideration and further development. Elements of the advice may also

relate to employment relations issues. The report will also be provided to the Employment Relations

Strategy Group to ensure access to this information when considering strategic employment

relations advice in relation to this workforce.

1.1 Background

This advice is provided for the purpose of informing the workforce group.

Ongoing health workforce development is a key accountability for DHBs and has a significant impact

on DHB outcomes. The Workforce Strategy Group (WSG) has an operational governance role over

the 20 DHB’s workforce activity and has mandated a range of advice to ensure that annual

workforce planning via Strategic Workforce Services (SWS) is well supported. Operational advice on

the employed workforce is developed by DHB experts and is complementary to the strategic advice

provided by Health Workforce New Zealand (HWNZ).

The purpose of the operational advice is to ensure that annual workforce planning processes have

the required level of workforce analysis, wherever additional focus or information is required. It is

about improving overall accuracy of information to this group in order to allow informed decisions to

be made regarding any potential intervention required. The purpose is to identify any staffing

capacity and/or capability issues related to DHB operational delivery and/or service development

needs, some of which may be addressed through the annual DHBSS workforce workplan process.

This paper provides summary advice to the workforce group on the current status of the DHB

medical laboratory workforce. The catalyst for this paper commencement is the upcoming 2016

Medical Laboratory Workers Multi Collective Employment Agreement (MECA) negotiations with the


NZMLWU, the DHBs and the NZBS. This information is provided for the purpose of informing the

development of a bargaining strategy in preparation for the 2016 Medical Laboratory Workers

MECA. The intent of the operational advice is to ensure that Bargaining Strategy Groups have access

to accurate information on the current status of the DHB medical laboratory employed workforce.

1.2 Context

The previous Medical Laboratory Workers MECA was settled in August 2014 and expires on 4

September 2016. A minor extension to the term of the current MECA was agreed last year to

incorporate several projects completed by the National Laboratory Engagement Group (NLEG).

There are 13 DHBs who are party to the current MECA:

Northland, Waitemata, Auckland, Counties Manukau, Waikato, Lakes, Hawkes Bay, Taranaki, Hutt

Valley, Capital & Coast, West Coast, Canterbury, and Southern.

*** Hutt Valley and Capital & Coast DHBs have contracted out their laboratory services to a private

laboratory since the last MECA was negotiated and will not be part of the 2016 bargaining.

The NZ Blood Service is also a party to the MECA.


2. Medical Laboratory Services in New Zealand

2.1 The Medical Laboratory Workforce Defined

The Medical Laboratory Workers (MLW) workforce includes two distinct professions: Medical

Laboratory Scientists (Scientists) and Medical Laboratory Technicians (Technicians).

Medical laboratory science involves the collection, receipt, preparation, investigation and analysis of

samples of human biological material for the purpose of supporting diagnosis, monitoring,

management and treatment of diseases and medical conditions; and for the maintenance of health

and wellbeing.

Medical laboratory science comprises a number of distinct disciplines including:

Biochemistry Embryology Molecular Diagnostics/Genetics

Blood Donor Services Haematology Mortuary Practice

Blood Transfusion Services Histology Phlebotomy

Cytogenetics Immunology/Virology Point of Care Testing (PCT)

Cytology Microbiology Specimen Services

The practice of medical laboratory science also includes:

Medical laboratory management

Medical laboratory science research and development

Medical laboratory science teaching

Medical laboratory quality management

2.2 Service Provision

Current arrangements around the provision of community and hospital medical laboratory services

in New Zealand, varies considerably between DHB regions and across the country. This is due to the

mixed DHB and / or private provider service provision models in place.

Additionally, there are some regionally specific arrangements such as:

DHBs retaining particular functions or units while outsourcing all other medical laboratory services to a private provider, e.g. Lakes only retains a mortuary function at Rotorua Hospital with casual staff;

A single laboratory providing nearly all services in that region, e.g. The West Coast DHB Laboratory with support from Canterbury Health Laboratories;

Hospital laboratories undertaking some community testing, e.g. Northland DHB covers smaller rural areas without Northland Pathology collection centres such as Kaitaia; and

Community laboratories providing tests at hospital outpatient clinics, e.g. Southern Community Laboratories covers community and hospital labs for the Southern DHB.


2.3 Medical laboratory service provision arrangements by DHB

DHB Hospital Laboratory Services Community Laboratory Services

Auckland Auckland DHB’s LabPlus Diagnostic Medlab

Labtests

Auckland DHB’s Anatomic Pathology Services -community anatomical pathology & histology

Counties Manukau Counties Manukau DHB Diagnostic Medlab

Labtests


Northland Northland DHB Northland Pathology

Northland DHB covers areas without Northland Pathology collection centres

Waitemata Waitemata DHB Diagnostic Medlab

Labtests


Lakes District Laboratory Services Rotorua

Southern Community Laboratories (SCL) services Taupo

Lakes District DHB operates the Rotorua Hospital Mortuary

Laboratory Services Rotorua

SCL services Taupo

Bay of Plenty Pathlab Pathlab

Waikato Waikato DHB Pathlab

Waikato DHB provides some community laboratory services for small south Waikato towns such as TeKuiti, Taumarunui, Tokoroa and Thames

Tairawhiti TLab (a joint venture between Medlab Central and the DHB)

TLab (a joint venture between Medlab Central and the DHB)

Taranaki Taranaki DHB Taranaki Medlab provides community laboratory services, anatomical pathology and histology tests.

Canterbury Health and the New Zealand Blood Service in Waikato provide specialist testing and advice

Capital & Coast Wellington SCL (owned by SCL) Wellington SCL (owned by SCL)

Hawkes Bay Hawkes Bay DHB SCL

Hutt Valley Wellington SCL (owned by SCL) Wellington SCL (owned by SCL)

MidCentral Medlab Central

Auckland DHB’s LabPlus

Medlab Central

Wairarapa Wellington SCL (owned by SCL) Wellington SCL (owned by SCL)

Whanganui Medlab Central Medlab Central

Canterbury Canterbury DHB’s Canterbury Health Laboratories SCL

Nelson Marlborough Medlab South (owned by SCL)) Medlab South (owned by SCL))

South Canterbury Medlab South (owned by SCL)) Medlab South (owned by SCL))

Southern SCL

Southern DHB operates the hospital mortuary

SCL

West Coast West Coast DHB

Canterbury DHB’s Canterbury Health Laboratories

Canterbury DHB’s Canterbury Health Laboratories


3. The DHB Medical Laboratory Workforce Overview

Over the long term, the overall DHB medical laboratory workforce distribution has diminished due to

laboratory services increasingly being contracted out to private providers. There are currently only

11 DHBs who employ medical laboratory workers: Northland, Waitemata, Auckland, Counties

Manukau, Waikato, Lakes, Hawkes Bay, Taranaki, West Coast, Canterbury, and Southern.

There is considerable disparity in FTE numbers between DHBs and regions, as evidenced in the

tables below. Lakes DHB has only retained a mortuary service which employs casual staff, so it has

no FTE for the purpose of this report. Similarly, the Southern DHB only employs 3 FTE in its mortuary

service.

DHB Scientist FTE Technician FTE Total %

Auckland 198.1 89 287.1 28.30%

Canterbury 108.1 81.1 189.2 18.60%

Waikato 78.3 58.2 136.5 13.40%

Counties Manukau 63.3 66.4 129.7 12.80%

Waitemata 58.7 51.7 110.4 10.80%

Northland 40 20.7 60.7 6.10%

Hawke's Bay 27.3 29.8 57.1 5.60%

Taranaki 14.8 13.5 28.2 2.80%

West Coast 7.9 5.1 13 1.30%

Southern 0 3.3 3.3 0.30%

Lakes 0 0 0 0

Total 596.4 418.7 1015.1 100.00%

DHB Scientist FTE Technician FTE Total %

Northern Region 360.1 227.8 587.9 58.0%

Southern Region 116.0 89.5 205.5 20.2%

Mid-Central Region 93.1 71.7 164.7 16.2%

Central Region 27.3 29.8 57.1 5.6%

Total 596.4 418.7 1015.1 100.0%

HWIP trend analysis from 2013 to 2015 indicates that the overall number of DHB employed MLWs

has experienced 0% change and is currently 1203. Given that during this period the number of DHBs

employing MLWs reduced from 13 to 11, the unchanged headcount indicates that the number of

MLWs employed by the remaining 11 DHBs increased. This growth is largely influenced by changes in

the Northern Region, particularly the transition to Anatomical Pathology Services being managed by

the Auckland DHB.


The DHB medical laboratory workforce comprises 58% scientists and 42% technicians. During the

period 2013 to 2015, the number of scientists decreased by 1% to 692, while the number of

technicians increased by 2% to 511. The Northern Region has a headcount of 686, which is 57% of

the overall DHB headcount. Since 2007 the number of scientists in the Northern Region increased by

28% to 417 and the number of technicians increased by 67% to 269.

With 587.9 FTE the Northern Region currently has the highest FTE of scientists and technicians, i.e.

58% of the overall DHB medical laboratory workforce FTE. The overall mean FTE is 0.84 indicating a

high number of part time workers. The mean FTE for scientists has consistently been higher than

technicians, and is currently 0.86 and 0.82 respectively.

80% of the current workforce is female, with both the proportion of female scientists and

technicians having decreased slightly to 76% and 86% respectively since 2013.

The overall mean age is high at 46.9 years. There has been a steady increase in the mean age for

both scientists and technicians, which are currently 46.5 and 47.4 years respectively. 33% of DHB

MLWs are under 40 years; 21% are 40 to 49; 41% are between 50 and 65 years, i.e. up to 15 years

away from retirement age; and 5% are 65+ years and working beyond retirement age. The charts

below illustrate the age distribution across the two main MLW occupation groups.

41% of female and 36% of male scientists are more than 50 years old; while 45% of female and 29%

of male technicians are more than 50 years old. Currently, for both scientists and technicians 5% of

females and 7% of males are more than 65 years old and working beyond retirement age.

The difference between workforce ethnicity and population ethnicity proportions indicates under-

representation of Māori and Pacific groups and disproportionately high representation of Asians,

especially for technicians in the Northern Region. The majority of MLWs are classified as ‘Other’

ethnicity, however an exception to this national trend is the Northern Region which has a higher

proportion of Asian technicians than the proportion of technicians classified as ‘Other’.


The annual turnover rate is 8.3%. The annual turnover rate has generally been higher for technicians

than for scientists, except between 2010 and 2012. While the annual turnover rate for scientists has

fluctuated between 6-12.5% between 2008 and 2015, the actual number of scientists leaving is

small. The overall mean Length of Service (LoS) increased to 10.9 years, and has consistently been

higher for scientists than for technicians.

In March 2014 the DHB MLW workforce was 36.13% of the overall New Zealand MLW workforce.

Since 2007 the number of New Zealand graduates registering as MLWs has been increasing, while

the number of overseas qualified new registrations has been decreasing. The United Kingdom

continues to be the major source country for scientists, while the Philippines remains the major

source country for technicians. The number of work visas issued to foreign MLWs has also been

decreasing in recent years. These trends indicate a decreasing dependence on overseas qualified

MLWs.

The key statistics suggest an aging workforce, which is changing in distribution and composition,

concentrated in the Northern region, with a higher proportion of scientists, dominant female

representation, a volatile turnover, long lengths of service, decreasing dependence on overseas

qualified workers, under-representation of Māori and Pacific and disproportionately high

representation of Asian. A detailed Workforce Information Report is included at Appendix 1.


4. Current Status of the DHB Medical Laboratory Workforce

4.1 Overall Assessment of the Medical Laboratory Workforce

The current status of the DHB employed medical laboratory workforce was assessed by DHB sector experts using a structured screening tool. (Appendix 2)

The screening tool assigns a score to the workforce being considered according to:

Service Need The operational stability/instability of the service

Supply Demographic factors impacting on the overall availability of this workforce

Operational Flexibility Operational flexibility around this workforce for service delivery and innovation

Operational Capacity Recruitment and retention

The purpose of the screening tool is to provide an overall assessment of the workforce to highlight any pressures impacting on the workforce operationally and/or in the context of employment negotiations. The results of the screening place the workforce in one of 4 categories as shown in the figure below. Results should be considered indicative only.

Health Workforce Classification Table

Overall Classification Intervention Overall Score

Stable Occupation WATCHING BRIEF 4 < 6

Transitional Occupation SOME INTERVENTION RECOMMENDED ≥ 6 < 10

At Risk Occupation INTERVENTION REQUIRED ≥ 10 < 15

Occupation Under Pressure INTERVENTION IMPERATIVE ≥ 15

Preliminary assessment of the current status of the DHB medical laboratory workforce by sector experts has identified this workforce as a Transitional Occupation.

DHB Medical Laboratory Workforce Classification

Transitional Occupation - SOME INTERVENTION RECOMMENDED

Domain Assessment Score

Service Demand

Service demand is progressively increasing and there are some instances of demand pressure on service.

2.4

Supply There are some distribution and supply issues, but these are localised issues (i.e. with specialisations and geographic locations), rather than the entire workforce.

2.1

Operational Flexibility

There are emerging requirements for more flexible workforce options however there is limited substitution that can occur.

2.6

Operational Capacity

Some recruitment and retention issues are occurring, with slightly longer timeframes for gaining this workforce in areas of specialisation and for rural locations.

1.9

Total Score 9


DHB MLWs FTE Distribution & Workforce Assessment Classification

DHB Scientist

FTE Technician

FTE Total FTE

% Hospital

Laboratory Services

Other DHB

Services

Community Laboratory

Services

Service Demand

Supply Operational

Flexibility Operational

Capacity Total Classification Intervention

Auckland 198.1 89.0 287.1 28.3% Community anatomical pathology

& histology services

x 3 2.5 3.5 3 12 At Risk

Occupation INTERVENTION

REQUIRED

Canterbury 108.1 81.1 189.2 18.6% x x 2 2 2 2 8 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

Waikato 78.3 58.2 136.5 13.4% x x 2 1 2 1 6 Stable

Occupation WATCHING BRIEF

Counties Manukau

63.3 66.4 129.7 12.8% x x 3 1 3 1 8 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

Waitemata 58.7 51.7 110.4 10.8% x x 2 2 3 2 9 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

Northland 40.0 20.7 60.7 6.1% x x 4 3 4 3 14 At Risk


REQUIRED

Hawke's Bay

27.3 29.8 57.1 5.6% x x 3 3 2.5 2.5 11 At Risk


REQUIRED

Taranaki 14.8 13.5 28.2 2.8% x x 2 2.5 2.5 2 9 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

West Coast 7.9 5.1 13.0 1.3% x x 1 2 1 1 5 Stable


Southern 0 3.3 3.3 0.3% x Mortuary

only x Stable


Lakes 0 0 0 0 x Mortuary

only x Stable


Total 596.4 418.7 1015.1 100% 2.4 2.1 2.6 1.9 9 Transitional Occupation

SOME INTERVENTION

RECOMMENDED


4.2 Rationale

Analysis of the DHB medical laboratory workforce has resulted in the classification of a Transitional

Occupation. This classification highlights that there is considerable variation between DHBs and

regions in terms of workforce size and around the private/DHB models that are currently in place.

These contextual issues make it challenging to present a national or regional assessment score with

a reliable level of validity. Therefore, the workforce assessment scores have also been examined at

DHB level to provide a more accurate analysis of each DHB’s situation in terms of its medical

laboratory workforce.

Key findings include:

Service demand is variable between DHBs, dependent on geographical location and the

populations they service. Overall service demand is progressively increasing due to

increasing and changing population demands, as well as the success of national health

programmes requiring medical laboratory tests; with peak demand pressures on laboratory

services such as histology. Service demand and provision is also changing within the medical

laboratory context.

While there is an overall stable supply pattern, there are some emerging distribution issues

and wider issues with supply. However, these are localised issues rather than the entire

workforce, i.e. with particular areas of specialisation, management roles and certain

geographic areas. The DHB medical laboratory workforce is changing in distribution and

composition. There is considerable variation in the supply patterns being experienced by

individual DHBs. This appears to be largely dependent on geographic location. DHBs with

large urban populations are experiencing sufficient and in some cases an over supply of

medical laboratory workers, while other DHBs with rural populations are facing supply

challenges.

There are no significant workforce flexibility issues. This workforce comprises largely

technically specialised roles with specific qualifications and scopes of practice. Hence, there

is no flexibility in terms of scopes of practice, work and areas of specialisation. There are

some emerging requirements for more flexible workforce options for the DHB medical

laboratory workforce, however there is very limited substitution that can occur. This is being

addressed through multi-skilling staff, flexible work arrangements to enable coverage and

the use of enhanced technological capability to increase flexibility in the way work is

organised.

DHBs vary considerably in terms of operational capacity. Many DHBs are experiencing no

significant recruitment and retention issues and there is generally easy access to this

workforce when required. However, internationally and nationally, there are generalised

recruitment and retention issues in areas of specialisation and for leadership roles, with

longer timeframes for gaining this workforce. Additionally, DHBs with rural laboratories are


experiencing difficulty recruiting and retaining staff for rural locations. As a result some

DHBs operational environments are being affected by potential lack of this workforce, due

to the higher level of workforce specialisation required within the medical laboratory

context. The high numbers of retirements in this ageing workforce also impacts on

retention. Additionally, age related health issues can be complex to manage.

On 01 February 2016, the Medical Sciences Council made significant changes to the

registration requirements and scopes of practice for medical laboratory science practitioners

in New Zealand. These changes are likely to have significant implications for the DHB medical

laboratory workforce.

Overall, the DHB medical laboratory workforce is in a state of transition with considerable

variance between DHBs, depending on regional service provision arrangements, workforce size

and geographic location. There are a few long standing issues around recruiting for particular

areas of specialisation and rural areas, as well as managing issues relating to the ageing workforce

demographic. No significant priorities have been identified for the DHBs to address through the

bargaining strategy.


4.3 Summary of the Current Status of the DHB Medical Laboratory Workforce

Summary of Key Service, Operational Workforce and Employment Drivers

1. Operational Service Needs

Current Changing in distribution and

12 month outlook No major changes foreseen

1 - 3 years outlook Watching brief in regards to volume increases

2. Employed Workforce Structure (Demography)

Average age Ageing workforce with an average age of 42.9 years.

Gender balance Predominantly female part time workforce with the risk of losing workforce numbers during childbearing years

3. Recruitment Current vacancies There are issues with particular specialisations and rural regions

Average time to fill No reported issues

Distribution Changing in distribution

Pressures on related workforces

No reported issues

4. Retention Factors Turnover Has been volatile but is currently relatively low

Sick Leave No reported issues

Part-time /Fulltime A part time workforce with a 0.92 mean FTE

Skill Mix No reported issues

Access to Clinical leadership

No reported issues

Clear career path No reported issues.

Development No reported issues

Workload management No reported issues

Roster management Some inconsistencies between business units

5. Ongoing Training and Development

Entry/ Transition competency

No reported issues

Match to service requirements

No reported issues

Access to ongoing training (progression)

There are issues around CPD funding

Access to training to maintain practising cert

No reported issues

Key

Working Well - no current problems, no immediate action required

Moderate Alert - action required in short / medium term

High Alert - immediate action required, extreme risk to occupation group


4.4 Workforce Assessment

4.4.1 Service Demand

Service Demand is about the demands on a particular service and associated workforce, and it

relates to the need for service provision within the environment or context being examined.

Service demand is variable between DHBs, dependent on geographical location and the

populations they service. Overall service demand is progressively increasing due to increasing and

changing population demands, as well as the success of national health programmes requiring

medical laboratory tests; with peak demand pressures on laboratory services such as histology.

Service demand and provision is also changing within the medical laboratory context.

DHB Medical Laboratory Service Demand Ratings

Rating

1 2 3 4

Service is stable and there are no anticipated major changes to service delivery or demand in the

short term

Some instances of demand pressure on

service but the majority of the time it is stable

overall.

Service demand progressively increasing / impacting on service level or peak demand

periods increasing.

Service operating at full capacity, peaks in

service demand driving instability in service

delivery.

% of DHB MLWs

1.3% 45.6% 46.7% 6.1%

DHBS

West Coast

Southern

Lakes

Canterbury

Waikato

Waitemata

Taranaki

Auckland

Counties Manukau

Hawke's Bay

Northland

Considerations include:

Service demand is increasing and changing as technology, population needs and clinician

requirements change.

Population growth and variegation are some of the factors driving increases in service

demand. There are increasing population demands impacting on service demand. Service

demand has increased significantly for Counties Manukau, Northland and Waitemata. This

increase is due to dramatic population growth, increases in population groups with high

health needs, and a steadily increasing aging population’s needs. Auckland DHB has not

experienced remarkable population growth; however there has been significant change in

cultural diversity which has resulted in a changed demographic population. This has resulted

in service demand increasing and workload increases in ‘acute’ health issues. Many

population sub-groups are accessing secondary care rather than primary care. Therefore

there is a requirement for more complex assays. There are also issues obtaining skilled or

specialised staff to meet the changing needs. Canterbury DHB is finding that variations in the

community and population; as well as increasing and changing expectations from consumers

are impacting on service demand.


There are changes to clinical practice which result in changes to service demand and

requirements, e.g. testing requirements and companion diagnostics.

Changes to operational requirements impact on service demand, e.g. changes to surgical

schedule or changes to collection of samples.

There are pressures around national initiatives. National health programmes and Ministry of

Health performance targets impact on service demand and requirements. The Ministry of

Health is working with the health sector to ensure patients have timely access to

appointments and tests which detect cancer and support cancer treatment. This work is

being done by the Faster Cancer Treatment (FCT) programme which aims to improve the

quality and timeliness of cancer diagnostic and treatment services for patients along the

cancer pathway. DHB medical laboratory service demand is being impacted on by the FCT

programme indicators. The Hawkes Bay DHB is experiencing severe demand pressures on

laboratory services, particularly in Histology, resulting from increasing numbers of cancer

referrals due to the success of the FCT programme. Additional pressure is expected as the

volume of referrals and medical staffing continues to increase.

The Bowel Cancer Programme is another growth area in terms of service demand. The

Ministry of Health established a Bowel Cancer Programme in 2009 to lead work aimed at

improving bowel cancer outcomes for all New Zealanders. The programme priority is to

strengthen bowel cancer services across the country to effectively meet the current demand

and increased demand in the future. This involves ensuring diagnostic, surveillance and

treatment services are working effectively and to a high standard. A four-year bowel

screening pilot began in late 2011 to determine if a bowel screening programme should be

rolled out nationally. In May 2015, the pilot was extended to December 2017.

Point of Care Testing (POCT) is also impacting on service demand, particularly in supporting

remote communities. Due to its varied nature, risks associated with POCT are higher than

those associated with testing in the environmentally controlled pathology laboratory.

Therefore, laboratory expertise is still required to support these services to ensure accurate

results.

Care areas are changing which is impacting on service demand and requirements. The

Waikato DHB’s work volumes have been decreasing recently due to the implementation of a

project which has reduced ‘unnecessary’ testing. This has been clinician driven and is based

on overseas models adapted for the local context. However, this balanced by changing

service needs which has seen an increase in demand for genetic testing and histology. This is

attributed to the new techniques available and more rapid testing, e.g. cancer markers.

The Canterbury DHB is also finding that service demand is changing and is variable

depending on specialty areas and particular services. There is increasing demand for

cytogenetic testing, which is a branch of genetics that involves analysing cells with an

emphasis on chromosome analysis for the detection of inheritable diseases. While there


appears to be low volumes, this area of work can be labour intensive and requires specialist

skills.

Medical laboratory science, pathology, scientific and technological advances are moving

relatively quickly so it is anticipated that there will be a continuing need to develop and

transition the medical laboratory workforce to meet changing needs. With increased use of

automated technology, laboratory scalability to meet volumes in high volume testing areas

is achievable often without investment in additional staff.

New strategies are regularly being developed and led at a national level, e.g. the change of

primary cervical screening to HPV testing. Therefore, the provider laboratories have the

challenge of maintaining a workforce until new services are in place and then maintaining a

specialised workforce where some are still needed but will have less work and then

transitioning others into other disciplines. To ensure service continuity, laboratories need a

critical mass of core staff irrespective of the volumes. It is similar for technology, diagnostic

or technique changes, such as traditional cytogenetics moving to molecular techniques.

Laboratories work with staff to transition over a period of time to new disciplines.

Service provision requirements and operating hours for medical laboratories are changing

across most DHBs, as a result of service demand and the drive to be more responsive. In the

Northern Region services are now provided 24/7 over multiple sites due to increases and

changes in service demand. Other DHBs are finding that the shifts in volumes has resulted in

laboratories running evening shifts. At times there are short term pressures in some of the

more specialised areas. There has been a shift in some specialties in timing of workload

(usually later in evening) and therefore a need to match resources to this demand or the

need to shift demand. This type of service model requires a particular skill mix and changes

to the way rosters and work are organised.

There are also increased pressures in terms of the aging workforce, reducing hours and time

out for parental leave. These issues also impact on capacity for supervision.

The increased shift of care into the community is likely to lead to higher service demand at

community collection centres.

The Northland DHB experiences seasonal increases in service demand due to population

peaks during holiday periods.

The West Coast DHB services a relatively stable population. Since the singular laboratory

provides all services for the region, there is certainty of workload. A lot of the required

hospital and specialist testing is performed by Canterbury DHB.

The Auckland DHBs are finding that outsourced services sometimes have to be picked up by

DHB laboratories if schedules are behind. However, other DHBs are finding that some of

their work is being outsourced to the private sector to meet service demand, creating an

interesting dynamic.


4.4.2 Supply

Supply is about the actual quantity and distribution of a workforce, including current demographics

and the quantity and quality of students / graduates.

While there is an overall stable supply pattern, there are some emerging distribution issues and

wider issues with supply. However, these are localised issues rather than the entire workforce, i.e.

with particular areas of specialisation, management roles and certain geographic areas. The DHB

medical laboratory workforce is changing in distribution and composition. There is considerable

variation in the supply patterns being experienced by individual DHBs. This appears to be largely

dependent on geographic location. DHBs with large urban populations are experiencing sufficient

and in some cases an over supply of medical laboratory workers, while other DHBs with rural

populations are facing supply challenges.

DHB Medical Laboratory Supply Ratings

Rating

1 2 3 4

No major distribution or supply issues, overall stable supply pattern.

Some distribution issues emerging and

wider issues with supply, but localised

issues (i.e. with a particular speciality), rather than the entire

workforce.

Distribution and supply issues increasingly impacting on wider system. Issues with

overall size of workforce available.

Significant distribution and or supply issues currently occurring, problems with small

size of available workforce. Real issues

with the pipeline supply for this workforce.

% of DHB MLWs

26.2% 61.8% 11.7% 0

DHBS

Waikato

Counties Manukau

Auckland

Canterbury

Waitemata

Taranaki

West Coast

Northland

Hawke's Bay


There is sufficient supply available in terms of new graduates and technicians; as well as at

mid / intermediate capability level.

However, there are supply issues in certain areas of specialisation unique to this area of

work, e.g. tissue typing. It is difficult to source technical specialists with the appropriate

experience.

Due to the shifting landscape of medical laboratories in New Zealand over the last 10 years,

the DHB medical laboratory workforce has also been in a state of change. Over the long

term, the overall DHB medical laboratory workforce distribution has diminished due to

laboratory services increasingly being contracted out to private providers. Indications are

that this trend is likely to continue. There are currently only 11 DHBs who employ medical

laboratory workers: Northland, Waitemata, Auckland, Counties Manukau, Waikato, Lakes,


Hawkes Bay, Taranaki, West Coast, Canterbury, and Southern. There is considerable

disparity in FTE numbers between DHBs and regions. Lakes DHB has only retained a

mortuary service with no permanent FTE. Similarly, the Southern DHB only employs 3 FTE in

its mortuary service.

The overall number of DHB employed MLWs is currently 1203. The majority are

concentrated in the Northern Region (58%) followed by the Southern Region (20.2%). The

Central Region (5.6%) has the lowest proportion of DHB MLWs, while the Mid-Central Region

comprises the remaining 16.2%.

The composition of the DHB medical laboratory workforce is also changing. The proportions

of scientists and technicians vary significantly between DHBs depending on operating

models and technological infrastructure. The needs of the workforce are changing, so

technical and scientific ratios are also likely to change.

The key statistics indicate that the DHB medical laboratory workforce is aging, changing in

distribution and composition and is concentrated in the Northern region. It comprises a

higher proportion of scientists, with dominant female representation, a volatile turnover,

long lengths of service, decreasing dependence on overseas qualified workers, under-

representation of Māori and Pacific and disproportionately high representation of Asian.

There is sufficient supply available in terms of new graduates and technicians; as well as at

mid / intermediate MLW capability level.

Since 2007 the number of New Zealand graduates registering as MLWs has been increasing,

while the number of overseas qualified new registrations has been decreasing. The number

of work visas issued to foreign MLWs has also been decreasing in recent years. These trends

indicate a decreasing dependence on overseas qualified MLWs. There are well qualified

overseas trained MLWs being recruited by DHBs, however there is decreasing reliance on

this source as there are sufficient numbers of MLWs available locally.

There are supply issues in areas of specialisation or sub-specialty. It is difficult to source

technical specialists or sub-specialists with appropriate experience and who are multi-skilled.

This is a long standing global and national issue.

There are also issues sourcing people for management positions, i.e. with technical skills and

leadership / people management skills. This may be because this workforce does not tend to

move between laboratories due to the market being too small, and some staff choosing not

to work in the private sector. There are also MLWs of very long tenure that are at the top of

their scientific scales but do not want to lead into their retirement years, and younger

emerging staff may see the step to a leadership role as too great. The remuneration gap

between private and public sector labs for scientific leadership positions is very large.

Although private laboratories usually have fewer leadership roles, as they do not have the

mix or sub-specialisations of DHB services, the private laboratories tend to remunerate their

leadership roles at a higher level than the DHBs.


There are no issues with the quantity and quality of graduates. However, many new

graduates need to be trained and appropriately transitioned from technician to scientist.

New graduates sometimes have unrealistic expectations, i.e. they have to undergo on the

job training which they often don’t expect and are unprepared for. Supervision, training and

mentoring staff involves a significant investment of resource and takes people away from

the functions of their core role.

Technology is having a significant impact on the MLW roles, i.e. it increases the on the job

training required. Information technology, informatics, work flow process design, etc. are

now integral in the MLWs work environment. This increases the on the job training needs as

well.

There are issues around the lack of training funds for specialised training and for funded

‘Trainee’ positions. Funding of Continuing Professional Development (CPD) is negotiated.

Training is needed to develop specialist skills, however funding is an issue. It can be difficult

for smaller DHBs and laboratories to keep up skills development and CPD. Additionally, the

DHB environment has a number of older staff who are unlikely to move and free up

opportunities for younger MLWs. There is also a tension between specialist vs generalist

capability development. The drive towards specialisation could create a shortage of

generalists over the long term.

There is an emerging trend of increasing numbers of fulltime staff reducing their hours or

wanting part time work. It is difficult to recruit to cover small FTE gaps. This increase in part-

time hours also puts pressure on service provision.

In the Northern Region, the current supply picture for the Auckland DHBs is possibly the best

it’s ever been historically for general MLW roles. However, the Northland DHB is having

difficulty sourcing scientists.

In the Mid-Central Region, there are no supply issues with general MLW roles. The Waikato

DHB is experiencing an oversupply of scientists, so some are taking up technician roles due

to a shortage of scientist roles. There have been issues around some staff wanting to

increase their FTE hours to more than 30 hours per week to meet immigration visa

requirements. While the Taranaki DHB has no supply issues, the hospital laboratories are

unsettled because it is unclear whether they will move to private providers. As a result, they

are currently not able to employ permanent FTE, which can make it challenging to recruit.

The Hawkes Bay DHB is the singular DHB within the Central Region which continues to retain

a medical laboratory workforce. Distribution and supply issues are increasingly impacting on

the Hawkes Bay DHB’s medical laboratory workforce and its ability to deliver effective

services. There are challenges recruiting appropriately trained and experienced MLWs due

to the rural nature of the region.

The Southern Region has an overall stable supply pattern for general MLW roles. Canterbury

DHB has an active intern and bridging course programme with technicians being supported


to transition into scientist roles, which also contributes to the DHBs supply. The West Coast

DHB’s workforce has been very stable with long tenure employees. They are currently

undergoing a period of change and are aiming to transform the workforce for future needs.

4.4.3 Operational Flexibility

Operational Flexibility is primarily about substitution of a workforce and the ability for other

workforces to potentially take on the roles involved. It includes specificity of skills and how

specialised particular roles / scopes of practice are in regards to delivery of required care. It is also

about how enabling or limiting a current scope of practice is on workforce utilisation.

There are no significant workforce flexibility issues. There are some emerging requirements for

more flexible workforce options for the DHB medical laboratory workforce, however there is very

limited substitution that can occur. This is being addressed through multi-skilling staff, flexible

work arrangements to enable coverage and the use of enhanced technological capability to

increase flexibility in the way work is organised.

DHB Medical Laboratory Operational Flexibility Ratings

Rating

1 2 3 4

No current workforce flexibility issues.

Some sector requirements to begin looking at alternative models of care and

roles for this workforce, as greater flexibility

required.

Emerging requirements for more flexible

workforce options. Substitution can occur,

however it may be difficult.

Requirements for flexible workforce options, but very

limited/no available substitute workforce that can perform the

critical function of this workforce.

% of DHB MLWs

1.3% 40.4% 51.9% 6.1%

DHBS

West Coast

Canterbury

Waikato

Hawke's Bay

Taranaki

Auckland

Counties Manukau

Waitemata

Northland


The medical laboratory workforce comprises specialised roles with specific qualifications and

scopes of practice. There is no flexibility in terms of scopes of practice and work. There is

also no flexibility with specialisations. This works well in this technically precise context.

There is limited ability to substitute, however some work could be carried out by other

workforces, e.g. specimen collection can be done by nurses and Point of Care Testing (POCT)

is increasing. In Phlebotomy there is regular transition from nursing and other clinical areas

into this specialty.


In terms of operational context, the various DHBs operate a number of different laboratory

teams in different geographic locations across New Zealand. The hours of operation for

these laboratories varies depending on service requirements related to location. Rosters are

managed locally.

Increasingly operational requirements are necessitating flexibility of operating hours in some

locations to meet work loads and service demand. Changes to work hours and rosters can

be difficult to execute due to the change management requirements in the collective

contracts. It can be complex and challenging to quantify what a ‘significant’ vs a relatively

‘minor’ change in rosters is, and to then reach the level of agreement required. There are

also some historical legacy issues with some staff not working weekends or working ‘school

hours’. Many DHBs are re-examining and addressing issues around how rosters are arranged

and organised.

There is the some level of flexibility in relation to terms and conditions of employment,

which can be used to create some flexibility around service provision and coverage.

However, there are diverse arrangements, silos and inconsistencies between and within

DHBs. Additionally, DHBs with low MLW FTE levels such as Taranaki, Hawkes Bay, West

Coast and Southern do not have sufficient staffing capacity for extra coverage.

Some cross training of staff is happening to enable staff to be multi-skilled to support their

rotation through functional areas. This is aimed at achieving better cross cover flexibility.

Waikato, Canterbury and West Coast DHBs are working with staff to optimise flexibility of

coverage by reorganising work and investing in training staff. These DHBs are cross training

staff to enable the rotation of staff through functional areas and thereby increase flexibility

of coverage. There is also an approach of getting staff to focus on less with a higher quality

focus. However, this approach involves a substantial investment of time and resource and

occurs over an extended period of time.

New technology is having a significant impact on the role and increases the on the job

training required. Information technology, informatics, work flow process design, etc. are

now integral in the MLWs work environment.

Technology changes are requiring and creating opportunities for more flexible work

arrangements. Waikato DHB is currently looking at using shared platforms to increase

flexibility, i.e. technology / machine platforms which require specific environmental

conditions. DHBs such as the Hawkes Bay DHB are considering automating more processes

and using POCT to increase flexibility and meet increasing service demand.

Point of Care Testing (POCT) is a new area which increases flexibility. The increasing drive for

POCT, often carried out by other health professional groups, is likely to have an impact on

the shape, size and look of the future MLW workforce. How patient care is supported within

their homes and communities with diagnostics is what needs to be considered, and what

role the MLS workforce will play in this.


There are some emerging needs for other scientist skills vs traditional medical laboratory

science skills. The ML workforce is moving from a total bench, hands on scientists, to experts

in process, automation and equipment, result interpretation, complementary knowledge

experts for referrers and patients, with specialisation in managing laboratory information

systems and bioinformatics.

There are some predictions that the future medical laboratory workforce may comprise less

scientists and more technicians due to automation as well as cost drivers, especially within

the community environment. A tertiary level research laboratory would have a slightly

difference mix. Conversely, other predictions are that increasing automation will reduce the

number of technicians required and bring a shift in the scientist role to be more consultative.

4.4.4 Operational Capacity

Operational Capacity is about recruitment and retention of a workforce. It includes availability and

the ability to buy / bring in more of a particular workforce as required.

DHBs vary considerably in terms of operational capacity. Many DHBs are experiencing no

significant recruitment and retention issues and there is generally easy access to this workforce

when required. However, internationally and nationally, there are generalised recruitment and

retention issues in areas of specialisation and fro leadership roles, with longer timeframes for

gaining this workforce. Additionally, DHBs with rural laboratories are experiencing difficulty

recruiting and retaining staff for rural locations. As a result some DHBs operational environments

are being affected by potential lack of this workforce, due to the higher level of workforce

specialisation required within the medical laboratory context.

DHB Medical Laboratory Operational Capacity Ratings

Rating

1 2 3 4

No significant recruitment and

retention issues and easy access to this workforce when

required.

Some recruitment and retention issues are occurring, with slightly

longer timeframes for

gaining this workforce.

Generalised recruitment and retention issues for

specialised skills. Operational environment is affected by

potential lack of this workforce due to higher level

of workforce specialisation required. Longer lead times i.e. 6 months to 1 year for

recruitment.

Significant recruitment and retention issues for

specialised skills. Issues exist with gaining appropriately skilled individual. Long and often difficult recruitment

processes for gaining sufficiently qualified

individuals i.e. 1-2 years for recruitment.

% of DHB MLWs

27.5% 37.8% 34.4% 0%

DHBS

Waikato

Counties Manukau

West Coast

Canterbury

Waitemata

Hawke's Bay

Taranaki

Auckland

Northland



There are some recruitment and retention issues, and pockets of difficulty relating to areas

of specialisation or sub-specialty. It is difficult to source technical specialists with

appropriate experience who are multi-skilled, especially in new and developing areas of

specialisation. This is a long standing international and national issue. Specialist skills are

very transferable and in high demand; so specialist staff can be targeted by the specialist

global market with shortages.

There are also issues sourcing people for leadership roles, i.e. with technical skills, leadership

and people management skills. Lead times can be greater and remuneration can be a

challenge. There are also better opportunities in the private sector in terms of remuneration

levels, career progression and Continuing Professional Development (CPD). Some DHBs with

larger MLW FTE numbers have some in-house leadership capability development training

available, however it can be a challenge for smaller regional DHBs who may not have the

resources or capacity to this.

Recruiting to rural areas can be difficult, as it involves getting people to move to small towns

which are often remote. The Hawkes Bay DHB has recently been experiencing a particularly

high turnover and difficulties recruiting suitably qualified staff for its rural hospital

laboratories. This challenging recruitment environment is resulting in longer time frames for

recruitment and leaving gaps in its workforce, which is adversely impacting on the operating

environment.

The Northland DHB has historically had a low turnover among MLWs, however more

recently there has been an increased turnover among young people and migrants.

Northland DHB is also struggling to recruit suitably qualified staff for its rural laboratories.

Challenges include multiple locations comprising small sites which need to be able to

provide multiple services. It is difficult to source the experienced multi-skilled staff needed

for these sites.

The Waikato DHB is also finding it difficult recruiting for rural laboratories. As a result the

Waikato DHB has relocated some rural work and increased FTE hours to be able to attract

better candidates. The Waikato DHB has no retention issues.

Access to training and lead in time can become a retention issue. Funding of Continuing

Professional Development (CPD) is negotiated. Training is needed to develop specialist skills,

however funding is an issue. It can be difficult for smaller DHBs and laboratories to keep up

skills development and CPD. Additionally, the DHB environment has a number of older staff

who are unlikely to move and free up opportunities for younger MLWs.

DHBs are also managing an increasing number of retirements, which impacts on retention.

Additionally, age related health issues can be complex to manage.


The high cost of living in Auckland impacts on recruitment and retention. Auckland is

particularly unaffordable for lower paid technicians. The Auckland and Waitemata DHBs are

finding that recruitment is difficult with the high cost of living in Auckland, and it is

particularly difficult to recruit technicians. Counties Manukau DHB has no recruitment and

retention issues.

Canterbury DHB has no issues with retention as there are few similar roles available in the

region. Canterbury DHB is finding that the instability in the MLW workforce due to the

increasing trend of shifting service provision to private providers, also contributes to the

workforce being very stable due to the need for job security.

The West Coast DHB currently has no issues with recruitment and retention, however this

could easily change as it has a small number of aging MLWs.

The Taranaki DHB’s medical laboratory service provision arrangements for is currently under

review. So the DHB is facing instability due to not being able to recruit permanent MLW FTE.

There are few similar roles available in the region, so they have no issues with retention.

The high numbers of females means that there are high levels of parental leave and people

not returning from parental leave, which impacts on retention.

New vetting requirements introduced under the Vulnerable Children Act 2014 can cause

delays and impact on recruitment.

Some DHBs have immunisation requirements which can result in delays as there is a

payment/cost component involved.

The recruitment process can be lengthy due to ineffective HR processes. Time to recruit can

also be impacted by time lags caused by internal processes and funding sign off.


4.5 Medical Laboratory Workforce Engagement Groups

There are a number of forums within the New Zealand medical laboratory sector which facilitate

collaboration at a national level. The main groups of interest to the DHBs are The National

Pathology and Laboratory Round Table (the Round Table) and the National Laboratory Engagement

Group (NLEG).

4.5.1 The National Pathology and Laboratory Round Table

The Ministry of Health (the Ministry) convened the National Pathology and Laboratory Round Table

(the Round Table) in 2010, with a view to strengthening engagement within the Laboratory and

Pathology sector. The group comprises of key sector leaders from DHBs, private and community

laboratories and the Ministry. It is chaired by the Chief Medical Officer and meets at least three

times a year. The Ministry of Health provides a secretariat function for the Round Table.

The purpose of the Round Table is to provide national leadership and independent advice on clinical,

scientific and strategic aspects of the Pathology and Laboratory sector. To achieve its purpose the

Round Table is tasked with working collaboratively with the wider health sector stakeholders to

strengthen engagement and collaboration within the Laboratory and Pathology sector. It uses

laboratory information to support the efficient planning and commissioning of health services for

populations; and informs investment in new health technology and procedures. It also ensures that

systems, processes and practices are in place to provide assurance to the health service about the

quality of laboratory and pathology services and information.

a) Workforce Related Activity

The Round Table’s current work programme includes a Workforce work stream which aims to define

a blueprint for the New Zealand Laboratory and Pathology workforce. Work commenced in late

2015 on identifying changes in the laboratory industry and workforce implications, as the first step

to describing a blueprint to consider and plan for future laboratory workforce requirements. This

includes defining the current state for the workforce, identifying changes in the industry, and

considering the response required to ensure the workforce is able to respond appropriately to

change. This provides opportunities for the DHBs to leverage of a coordinated national approach to

workforce planning and development.

b) DHB Membership

In October 2015, there were seven DHB representatives who were members of the Round Table.

They represent 51% of the DHB medical laboratory workforce.

The minutes from late 2015 indicate that there were concerns regarding attendance, participation

and the level of DHB representation. It would appear that there is a need for enhanced DHB

participation in this national forum.


At the August 2015 meeting, the Round Table discussed reviewing membership of the group, given

the relatively low attendance at recent meetings, and regular non attendance from some members.

It was agreed that a key focus would be to ensure there is appropriate high level DHB

representation, via Chair, CEO and GM Funder representation. Other membership would continue

based on usual attendees. As a result the agreed actions were to discuss having a DHB CE and a DHB

GM P&F representative with the DHB lead CE and Lead GM P&F.

It is proposed that the DHBs review representation on the Round Table to ensure effective

participation; and to leverage opportunities for addressing sector wide issues through this national

engagement group charged with responsiveness and advising on these matters.

c) Current Membership

Name Organisation

Chair Don Mackie Ministry of Health

DH

B R

ep

rese

nta

tive

s

Ross Hewitt Lab+ (Auckland DHB) 28.3% of DHB

MLWs Stephen Absalom Lab+ (Auckland DHB)

Gloria Crossley Taranaki DHB 2.8% of DHB MLWs

Carolyn Gullery Canterbury and West Coast DHBs

19.9% of DHB

MLWs David Meates Canterbury and West Coast DHB

Kirsten Beynon Canterbury and West Coast DHBs

Virginia Hope Capital & Coast DHB & Hutt Valley DHB 0

Other Sarah Prentice Northern DHB Support Agency

Pri

vate

Pro

vid

ers

Arlo Upton Labtests NZ

Mike Norriss Labtests NZ

Cynric Temple-Camp Medlab Central

Karen Wood Aotea Pathology

Peter Gootjes Southern Community Laboratories

Richard Massey Pathology Associates

Trevor English Otakaro Pathways

Pro

fess

ion

al

Org

anis

atio

ns Graeme Benny ESR (The Institute of Environmental Science and Research)

Ian Beer NZ Society of Pathologists

Michael Dray Royal College of Pathologists Australasia

Ross Boswell Royal Australasian College of Physicians

Union Deborah Powell NZ Medical Laboratories Workers Union


4.5.2 The National Laboratory and Engagement Group

A significant aspect of the January 2012 MECA settlement was the establishment of a National

Laboratories Engagement Group (NLEG) at the national level and local engagement groups (LLEGs).

This arose from the more constructive interests based bargaining approach pursued by the parties;

and was an acknowledgement by both parties that they needed to engage differently to avoid the

industrial conflict that had previously characterised bargaining with the NZMLWU.

The NLEG’s primary purpose is to function as a collaborative means of addressing issues that emerge

during the MECA bargaining process between the employers and the NZMLWU. The NLEG has been

successfully delivering on its purpose and has been beneficial in establishing common understanding

and in addressing matters that have been difficult to advance in an industrial setting.

While there are and are always likely to be on-going differences between the parties, previous

bargaining strategy papers have acknowledged that these are not as significant as previously was the

case. Therefore, there has been a correlating decrease in issues needing to be worked on through

the NLEG. This is a positive outcome and supports the need for the NLEG to perhaps continue albeit

in a changed capacity.

The NLEG is currently re-examining its membership composition and focus. Given the apparent

reduced need for addressing key issues and intervention activity, one option would be for the NLEG

to narrow its scope to focus only on addressing employment related issues as required. Wider

workforce issues could be addressed more effectively by leveraging of the broader perspective

offered by the Round Table’s workforce programme.

a) DHB Membership of the NLEG

The NLEG should include five NZMLWU representatives and five employer representatives, i.e. 1

NZBS, 1 COO representative and 3 other DHB representatives. It is to be expected that the member

representatives of any established group will be reviewed and changed periodically.

Over recent years the distribution of DHB MLWs has decreased, while the overall DHB MLW FTE has

increased by 17% since 2007 and is currently 1015.2. Given these changes to the distribution of DHB

medical laboratory service provision, it would be timely for the DHBs retaining MLWs to review DHB

representation to ensure appropriate and proportionate representation on the NLEG. Somewhat

proportionate representation could occur by selecting representatives based on regional workforce

size.

4.5.3 Canterbury Health Laboratories Annual User Group Meeting

Canterbury Health Laboratories annually invites laboratory managers and leaders from around New

Zealand, Australia and other countries to participate in their User Group meeting. Over the years the


meeting has moved from a predominantly scientific focus to include discussions on issues affecting

the industry’s future direction and sustainability. The Lab Meeting is recognised as providing a

valuable forum for senior medical laboratory associated people and those interested in the

pathology sector. The 2016 programme focuses on challenging current thinking to prepare for future

developments and new ways of working; including preparing the laboratory workforce as well as

developing current and emerging leaders.

This forum represents an advantageous opportunity for DHBs to participate in as it manages its

medical laboratory workforce through a landscape that is changing on a range of levels.

4.5.4 Other Groups

There are several other groups which support collaboration and engagement within the medical

laboratory sector in New Zealand, including:

• Laboratory Managers Group;

• Laboratory Information Systems (LIS) Managers Group;

• Laboratory Quality Managers Group

• Labnet (Collaboration between Canterbury, Taranaki, Hewkes Bay & West Coast DHBs); and

• Point of Care Advisory Group.


5. Operational Workforce Analysis

5.1 Regulatory Requirements for Medical Laboratory Workers in New Zealand

The Medical Sciences Council (the Council) of New Zealand regulates medical laboratory science

practitioners in New Zealand. The Health Practitioners Competence Assurance Act 2003 requires all

medical laboratory science practitioners to be registered with the Council; and they must also have

applied for and been issued with an annual practising certificate (APC) before they begin practising

in their registered scope/s of practice. Registration applies to a single scope of practice, and

practitioners will need to apply for registration for each additional scope of practice.

Registration is a one-off process. Medical laboratory science practitioners remain on the Register for

life once registered in a scope of practice, unless they are removed. Registration on its own does not

allow medical laboratory science practitioners to practice. They must also hold a current annual

practising certificate. Applying for registration and then an APC are two separate processes that are

completed online through the Council’s website.

5.2 Changes to Registration Requirements from 01 February 2016

From 01 February 2016 significant changes were introduced, including the creation of 6 specified

scopes of practice under which medical laboratory science practitioners in New Zealand may be

registered. The new scopes of practice are listed in the following table:

Medical Laboratory Scientist Medical Laboratory Technician Medical Laboratory Pre-Analytical Technician

Medical Laboratory Scientist (Provisional Registration)

Medical Laboratory Technician (Provisional Registration)

Medical Laboratory Pre-Analytical Technician

(Provisional Registration)

Medical Laboratory Scientist

(Full Registration)

Medical Laboratory Technician (Full Registration)

Medical Laboratory Pre-Analytical Technician (Full Registration)

Newly created

Includes Phlebotomy, donor technology, and specimen preparation /services

Some of the key changes introduced by the Medical Sciences Council of New Zealand are

summarised in the following table:

Role Changes from 01 February 2016

Scientists Introduction of Provisional Registration, requiring completion of a period of supervised practice before qualifying for Full Registration.


Medical Laboratory Technicians

A significant change for registration as a Medical Laboratory Technician came into effect from 1st February 2016. This is in relation to the Qualified Medical Laboratory Technician certificate (QMLT) as issued by the New Zealand Institute of Medical Laboratory Science (NZIMLS).

Previously Trainee Medical Laboratory Technicians worked under supervision in an appropriately accredited New Zealand laboratory for a minimum period of 2 years FTE. During that time they completed a logbook and once they had accumulated a total of 4000 clinical hours within the laboratory they could sit the QMLT examination. The QMLT certificate is only issued upon successful completion of the examination and evidence of having completed at least 4000 hours of clinical experience. At this point the Trainee applied for registration as a Medical Laboratory Technician.

From 1st February 2016, applicants must hold provisional registration as a Medical Laboratory Technician at the point of having successfully passed the QMLT examination which can be done after having completed a minimum of 6-calendar months of employment in an appropriately accredited New Zealand laboratory. Provisional registration will remain in place until such time as the Medical Laboratory Technician has been issued with the QMLT certificate by the NZIMLS. At that point they must apply for full registration in the Medical Laboratory Technician scope of practice.

Medical Laboratory Pre-Analytical Technicians (ML-PATs)

The introduction of a new scope of practice called Medical Laboratory Pre-Analytical Technician (ML-PAT).

The ML-PAT scope of practice encompasses the medical laboratory science disciplines of phlebotomy, donor technology, and specimen preparation (specimen services). While categorised as pre-analytical, the nature of the work performed within these disciplines is critical to the profession of medical laboratory science and has potential to cause harm to the public.

The Medical Laboratory Technician scope of practice used to include phlebotomy and donor technology, however specimen services was excluded from the defined parameters of the profession of medical laboratory science.

Many quality and service aspects of modern laboratories are directly impacted by the work of specimen services practitioners. Modern laboratory equipment is often loaded with samples by specimen services staff, effectively integrating this work into the analytical work flow. The potential risk of harm by this group of practitioners is significant enough to warrant their inclusion within a medical laboratory scope of practice.

There will be some transitional qualification pathways available for a short term to allow practitioners who have extensive experience in the discipline of specimen services to gain registration. Specimen services staff who perform data entry only are not required to be registered.

Sourced from The Medical Sciences Council’s Registration Guide: Medical Laboratory Science

Scopes of Practice – December 2015


5.3 Workforce Description

5.4 Key Service, Operational Workforce and Employment Drivers

The conducting of the occupational assessment tool highlighted the progressive increase of service

demand, issues with recruiting for rural laboratories and in areas of specialisation, CPD funding and

the need for greater service provision flexibility.

5.5 Service Delivery & Development Drivers

Service demand for medical laboratory services is influenced by population growth and overall

practitioner diagnostic treatment rate uptake. Sector feedback suggests that service demand

continues to grow for DHBs due to overall increasing complexity of new diseases, changing

treatment and diagnostic practices and the increased use of technology.

5.6 Demographics

The Workforce Information Report (Appendix 1) summarises demographic data relating to the DHB

medical laboratory workforce.

5.7 Current employed workforce

As well as service driven factors, DHB requirements for the medical laboratory workforce are

influenced by the characteristics of the current workforce:

5.7.1 Recruitment

The recruitment situation is relatively stable from a macro perspective.

a) Supply

No major recruitment drives are currently occurring within the DHBs for medical laboratory

staff. While there are issues with recruiting for rural laboratories and in areas of specialisation,

there are no significant workforce shortages currently occurring.

b) Distribution

No major recruitment drives are currently occurring within the DHBs for medical laboratory

staff. While there are issues with recruiting for rural laboratories and in areas of specialisation,

there are no significant workforce shortages currently occurring.

c) Vacancies

Apart from the longstanding rural issue there are no significant vacancies occurring nationally.


5.7.2 Retention

Retention is relatively stable nationally.

a) Workload Management:

The impact of increasing demand varies according to geographic location.

b) Workforce Mix:

No significant skill mix issues were reported by sector experts.

c) Clinical Leadership:

There is a need for this workforce to change the role it undertakes to remain relevant. As

greater automation occurs the workforce may need to add value with a more direct clinical role

or greater engagement with clinicians. There is a need for increased investment in management

/ leadership capability development.

5.8 Training and Development

5.8.1 Entry/ Transition Competency:

Sector evidence indicates that there are no issues with entry competencies from new graduates

entering the DHB environment.

5.8.2 Match to Service Requirements:

The current workforce is well matched to service requirements but the requirements will inevitably

change and the workforce will need to change with it.

5.8.3 Access to On-going Training (progression):

There are issues around the lack of training funds for specialised training and for funded ‘Trainee’

positions. Funding of Continuing Professional Development (CPD) is negotiated. Training is needed

to develop specialist skills, however funding is an issue. It can be difficult for smaller DHBs and

laboratories to keep up skills development and CPD. Additionally, the DHB environment has a

number of older staff who are unlikely to move and free up opportunities for younger MLWs. There

is also a tension between specialist vs generalist capability development. The drive towards

specialisation could create a shortage of generalists over the long term.


6. References

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of Health and Human Services Washington, DC: Health Resources and Services Administration.

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