Since July 2022, with the coming into force of the Pae Ora Act, Health New Zealand (HNZ) is responsible for managing all health services including (a) hospital and specialist services and (b) primary and other community care.
It is an amalgam of the abolished district health boards (responsible for the health of geographically defined populations) and the funding and planning functions of the Ministry of Health.
Te Whatu Ora: the weaving of wellness
Whenever discussing Health New Zealand I have referred to it interchangeably with its Māori name, Te Whatu Ora.
In fact, I’ve referred more to its Māori rather than English name. The reason, in part at least, it the beautiful meaning of Te Whatu Ora: ‘the weaving of wellness’.
In the context of Aotearoa New Zealand’s public health system words involve bringing two or more strands together to weave a basket; a basket of life.
Although I’m highly critical of the health restructuring under the previous Labour government, as a name Te Whatu Ora can’t be faulted.
Scapegoating workforce demeans HNZ’s Māori name
However, given its subject matter, I’m sticking with Health New Zealand for this particular blog. Its recent behaviour demeans its Māori name.
Rather than weave strands together this behaviour involves scapegoating the most valuable asset that HNZ possesses; its workforce.
Scapegoating is the act of blaming a person or group for something bad that has happened or that someone else has done. Examples include blaming immigrants for a country’s economic problems and blaming coaches or captains for a sport’s team’s poor performance.
Scapegoating precursor: a ‘fish rotting from its head’
Health New Zealand’s national operational leadership has just decreed that recruiting to fill all its staff vacancies or new positions, from cleaners and laundry workers to medical specialists and nurses, must now be approved by its national office.
This is an extraordinary position which makes a vulnerable workforce more vulnerable. Such is the level of fatigue and burnout arising out of the deadly vice of severe workforce shortages and rising acute demand, that it is critical that recruiting to fill positions is undertaken expeditiously.
The relevant expertise and expertise for making recruitment decisions in a timely manner resides much closer to where healthcare is provided.
A responsible employer committed to its workforce would not take this action. However, it is the action an insensitive employer living in an isolated bubble and consequentially divorced from workforce realities would take.
Waitemata Chief Medical Officer and cardiologist Dr Jonathon Christiansen gets it in one
It led a justifiably outraged Waitemata Chief Medical Officer, cardiologist Dr Jonathon Christiansen, to make the following erudite and biting comment in his regular newsletter to his medical colleagues:
Changes to delegations for recruitment to existing and new positions
The national directorate of Hospital and Specialist services has advised districts this week that, effective immediately, all recruitment for HSS staff (cleaners to senior clinicians) must be formally approved at the national office, whether that recruitment is to new positions or simply replacing existing positions that become vacant.
This directive beggars belief, and would have been suitable for release on Monday 1 April, where it might have been accepted in the spirit of foolishness the day is known for. Staff turnover in many frontline clinical (and non-clinical but essential – orderlies, cleaners etc) services can be significant (>10%), notice periods are typically only 4 weeks, and with 10s of 1000’s of employees nationally the logistics of this alone, let alone the rationale, are beyond my comprehension.
I am reminded of the Board Directors’ course I completed some years ago in Australia – a dead fish was drawn on the whiteboard at the opening lecture and remained there for the duration of the week’s residency. A visual reminder of the phrase variably attributed to an old Russian or Turkish proverb or to the writings of Erasmus: “A fish rots from the head”.
I’m reasonably confident that the number of HNZ staff, from cleaners to medical specialists, who disagreed with his critique could be counted on one hand (two hands at a push).
Is Health New Zealand a fish that rots from its head?
More scapegoating to come
Then, on 19 April, Radio New Zealand’s investigative journalist Phil Pennington broke a story about more widespread top-down controls from HNZ’s top leadership on its workforce: More extensive workforce measures by Health New Zealand revealed.
There were 14 measures decreed, all exclusively in the interests of improving HNZ’s precarious financial position before 1 July. These measures included:
- Every shift should have two of its staff on leave (to reduce accrued annual leave as a balance sheet liability).
- No double-shifts (these are due to severe workforce shortages for which there is no planning to address).
- No new non-clinical staff commencing before 1 July (thereby putting more pressure on a fatigued and burnt out clinical workforce).
- Consideration of permanently removing vacant staff positions (fudging the data on workforce shortages).
- No backfill for staff on sick leave, excluding night shifts (placing more pressure on remaining overworked staff).
This is all about cost-cutting as part of a desperate HNZ leadership seeking a breakeven position by the end of this financial year (30 June). It is without regard to the extra pressure this will put on an already fatigued and burnt out workforce.
On 22 April Radio New Zealand reported efforts by HNZ to downplay the significance of these measures: HNZ downplay and nursing rebuttal.
Margie Apa: spoke from an isolated bubble divorced from workforce reality
This report included links to earlier Morning Report interviews with HNZ Chief Executive Margie Apa and NZ Nurses Organisation President Anne Daniels.
The differences between Apa and Daniels could not be more stark. The former was someone in an isolated bubble believing in castles in the sky.
Anne Daniels: spoke from the frontline reality
The latter was someone who understood intimately what it was really like at the frontline. The contrast could not be greater. They work on different planets.
Why
Why is HNZ behaving like this towards its overworked staff? The short answer is that it under strong political pressure to breakeven this financial year and it is scapegoating its workforce, which it considers to be a balance sheet liability.
Thomas Coughlan reported HNZ’s $1billion deficit
On 5 April NZ Herald journalist Thomas Coughlan covered the report of the Health Select Committee on the performance of HNZ in its first financial year (1 July 2022-30 June 2023). This included the revelation a $1 billion financial deficit: $1 billion HNZ deficit in its first year.
HNZ top operational leadership’s jobs are on the line. If HNZ does not breakeven by 30 June then their future is uncertain. Few believe this objective will be achieved. Ironically HNZ’s leadership is not the reason for this financial position.
Instead it is a combination of poorly thought out restructuring by the previous government and increasing acute patient demand which is what the health system should be enabled to focus on.
There is simply is no excuse for scapegoating their workforce by treating them as a balance sheet liability.
Instead Health New Zealand needs to start weaving wellness for its own workforce, and quickly.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion
Ciggaretti should step up or leave the waka .He failed when on the northland DHB and is now failing at a national level.The buck stops with him he should have arranged more funding if and when its needed .HNZ is still trying to serve 5 million people with not even enough funding to serve 3 million.
He canned the new hospital in Whangarei on election night even though funding was in the last budget .Now he wont fund the new 150 bed wing at northshore because Labour delivered it so because national is so delude they will leave it to rot .
Come on Gordon. What’s a bit of urine running down the internal walls and windows falling out of the building when the rescue helicopter lands on the roof in the bigger scheme? Reti looks like he’s about to burst into tears every time he is interviewed. I’m sure he’s a perfectly nice guy but he should probably go back to being a GP.
“Instead it is a combination of poorly thought out restructuring by the previous government and increasing acute patient demand which is what the health system should be enabled to focus on.”
“Scapegoating is the act of blaming a person or group for something bad that has happened or that someone else has done. Examples include blaming immigrants for a country’s economic problems and blaming coaches or captains for a sport’s team’s poor performance.”
So rather than the actions of this government and everything mentioned above you used the previous government as a scapegoat.
The “coach” as you put it is the National Government
In regards increased acute patients, would that have anything to do with our increased immigration or a baby boom? The evidence is an increase in immigration. That is not scapegoating.
Ian we are back to the days of the Key government when the then Health minister Jonathon Coleman instructed the head of DHB’s to “Do more with less”. We have returned to that era(error).
And said Jonathon Coleman resigned from Parliament almost immediately after National lost the election (2017) and went straight into a highly paid executive position with a private health conglomerate.
That says all you need to know about any principled policy concerning public health that National/ACT and Coleman (and before him Tony Ryall), had and continue to have – zero principled policy!
Verity V. Fact is, Jonathan Coleman, MoH, provided the best response I’ve ever had from a politician, resulting in two procedures at Capital Coast Health being changed, including, incredibly, correspondence signed off “ Team Leader”, with no identifiable author and of no legal standing.
Fact is I’m still waiting a response from Helen Clark, shadow MoH, and have been sitting on her interim response since the 1990’s. This was re a personal experience at Wellington Hospital breast clinic, whose results I never got either. Think I may still have just an interim reply from Minister Paula too
Fact is, a few decades ago, med students and trainee interns at Wellington Hospital were carrying out gynaecological/ obstetric examinations on pre-anaesthetised female patients, without their knowledge or consent, who were awaiting non-related surgical procedures. This was stopped only when, quite rightly, the nursing staff kicked up a mighty fuss about it, after medicos and admin ignored their concerns.
Fact is this government, IMO, wants a privatised health service to replace the once good national health service. Ask Bill English. They do things by stealth, like burglars in the night.
Fact is Coleman privatized operation to clear a backlog they created. Fact is they froze nurses salaries for this to happen. Fact is Coleman created the drain to Australia.
But I’m pleased you liked Coleman Snow White.
High immigration is not, as many economists are wont to pretend, an ineffable solution. It has demonstrably f***ed wage growth, housing, and the last remaining shreds of credibility that once still hung from self-styled Left politicians.
Five million population on infrastructure for three? Immigration will only make everything worse.
Correct Stuart!
Margie Apa is only protecting her high paid salary. If she had any principles she would ignore the Governments directives and put her staff first and foremost. Instead, this government has set a very dangerous precedent and ultimately lives will be lost.
And I notice Reti is noticeably quiet, must be next on the chopping block.
You know what, for whatever reason people were pissed off with the labour government – but I don’t think many of them signed up for something like this.
And said Jonathon Coleman resigned from Parliament almost immediately after National lost the election (2017) and went straight into a highly paid executive position with a private health conglomerate.
That says all you need to know about any principled policy concerning public health that National/ACT and Coleman (and before him Tony Ryall), had and continue to have – zero principled policy!
To put it bluntly I could see this coming a mile off.
As NASC says this is a RETURN TO THE COLEMAN ERA only it is on spades x 10.
Patients and the workforce are going to pay the price.
Why did i see this coming ?
I have been a health campaigner for 14 years.
NATIONAL ALWAYS GUT THE HEALTH WORKFORCE and MEDICINES FUNDING.
Quite right Geoffrey. During our recent Multi Disciplinary meetings, our manager reported back from her governance meeting that we are no longer able to fund particular medications for our clients. Packages of care are to be restricted.
Without doubt we are in dark times.
I do certainly hope this simply is designed to come under budget and not to create a resource for tax cuts. I have not heard or read one comment to support tax cuts, of which only the very well off will benefit.
Yep. Last time I saw a doctor a couple of years ago, she told me what I should be taking, and to buy it from a pharmacist as it had been defunded after previously being available by prescription.The annoying thing was getting to the chemist warehouse and finding that there were several variations of the product the doc had named, leaving me to figure out what she may have meant.
Reti longs for US style healthcare.
Ian – The current CEO of Health NZ, is the former CEO of Counties – Manukau Health Board, NZ’s worst performing Health Board in terms of key Health outcomes…why is that person being promoted?
Don’t forget the performance bonus for hitting the targets….. + the all expenses trip to a medical management conference somewhere nice & warm in the middle of winter that all the highly paid managers will receive for reducing the budget expenditure + headcount!
Create a crisis….Tina…the ultimate aim is the privatisation (USA style) of our heath service!
I’ve e-mailed reti on several occasions concerning vaping(won’t bore you with the facts) no reply because he knows he doesn’t have one, so the only conclusion can be he is too chickenshit to have the debate, even with a powerless e-mailer