GUEST BLOG: Ian Powell – Train wrecks and election outcomes


On 19 June the Sunday Star Times published my column on the relationship between the Labour government’s stewardship of Aotearoa New Zealand’s health system and the outcome of the next general election expected to be around September-October 2023: Is the health system an electoral sword of Damocles for Labour.

Deteriorating workforce crisis is a health system crisis

I began by recognising that the incoming Labour-led government in 2017  inherited from its National-led predecessor a health system in crisis due to severe workforce shortages. Because of its centrality a workforce crisis is by definition a health system crisis.

However, while knowing this to be so, the new government largely ignored the pre-pandemic crisis and the pressures driving it such shortages, increasing acute demand greater than population growth, and worsening illnesses in communities largely due to social determinants of health.

The effect of this deteriorating situation impacted “…severely on access to planned surgery and other treatments, overcrowded emergency departments, availability of hospital beds, and compromised capacity to diagnose patients in a clinically timely manner.”

Covid-19 was not the cause of the workforce crisis; it was an accelerator.

The bigger accelerator

But government inaction was the bigger accelerator. This inaction was due to a mistaken belief that restructuring would somehow fix things despite evidence refuting this view. Government listened to business consultants rather than those with health system expertise.

The political context is that right now National and Labour are neck-and-neck in the opinion polls but the trend favours the former. Health is an important electoral issue because of its extensive impact on most New Zealanders.

Predictably the health system is now on its knees. The government is taking a public hiding with extensive media coverage of the terrible situation affecting patients and health professionals.

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But the new Health New Zealand, which takes over the leadership on 1 July will be unable to turn this around in a way that is both substantive and obviously so to voters. To start with its leadership at national and regional levels is largely comprised of interim appointees.

Strategies that need to be developed (and should have been developed years ago) will take time to both develop and implement. It is hard to do this in the leadership vacuum that we now have. Further, a bureaucratically centralist system is more likely not to get it right, at least in a timely manner.

I concluded by stating:

By the time of the next election the government will be in no position to blame the workforce crisis on DHBs or the previous government. Labour is trending in the polls towards being under Damocles’ Sword. It will certainly be under it by the time of the election.

Train wreck?

So does this mean that the health system is heading towards a train wreck? Certainly many with expertise in the health system believe so. But, in the current ‘command-and-control’ environment, they can only talk in corridor and café whispers.

The current situation is well illustrated in a devastating cartoon published in Stuff by Sharon Murdoch lampooning the health minister as ‘Dr Little’.

Sharon Murdoch on Dr Little


One thing is certain. Our already overworked and highly stressed health professionals will continue to provide the best possible care for the ill and very ill who are fortunate enough to access healthcare.

Health professionals can make a bad system work (somewhat) by navigating around obstacles and at the cost of the health. But a crisis of the magnitude that they are currently experiencing is much harder and even more dangerous to their health.

With a leadership vacuum leading to continued neglect of this workforce crisis that is likely to continue for some time, anticipating a train wreck is not an unreasonable call to make. Time will tell. It may come down to a question of not whether there is a train wreck, but the extent of its casualties.

The responsibility buck

It is easy to blame the hapless health minister for this fiasco. Certainly he has not handed the portfolio well. But Little is the ministerial implementer, not decision-maker, of the government’s approach. For decision-maker we have to look at Prime Minister Jacinda Ardern.

Responsibility buck rests with Jacinda Ardern


Prior to becoming prime minister Ardern had minimal understanding of how our health system works. She is accused by some on the political right of being too ideological. I disagree.

Dogmatic is a better descriptor. While she knew little about the health system, she had a predetermined negative view of its leadership and a preference for the advice of business consultants.

It was Ardern who went to EY senior partner Stephen McKernan to head the transition unit. It was Ardern who agreed to him continuing as an EY senior partner while in this role. It was Ardern who located the transition unit in her department with its head reporting directly to her.

And it was ultimately Ardern’s decision to restructure the system for delivering healthcare during a pandemic (difficult to think of what trumps this for sheer madness).

Dogmatism suggests that the Prime Minister is unlikely to see the light over this disaster. But, even if she does and is prepared to admit it, its too late. The damage is done.

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


    • Keepcalmcarryon. Agree, but National is just as bad, so the outlook is bleak. We used to be as good as the NHS, but are now following their path of running down our free public health system more sneakily than they are.

  1. Labour is poked for the 2023 election…what will be their election slogan in 2023 — ‘We saved you from Covid, now vote for us you ungrateful bastards”

    • I don’t think I’ve been exposed to covid yet and I’m not worried. I know plenty that have. I’d like to be saved from the health system.
      Unfortunately, any death is one death too many was only ever any ‘covid’ death…
      I’ve seen some horrors. I don’t know what level of governmental neglect brings us to the depths of ‘developing world’. I once said to a surgeon that working in public health meant there was no need to go overseas to join ‘doctors without borders’. I wasn’t being mean. I was thinking that it would be good to have their kids in schools and to go home at the end of the shift. I just assumed that would be harder working in similarly deprived services overseas. The surgeon laughed sadly.

    • As opposed to “if we had been in power a good number of you would have been dead well before the supposedly benign omicron variant showed up and we could have really shown you what a pandemic looks like, now vote for us”

  2. It beggars belief that Ardern sought advice from Ernst&Young rather than from top medical experts, and I mean practising medical practitioners, not self-important public health wallahs with no medical training who can appear to have their own agendas and be curiously ambivalent towards “real” doctors. Obviously she sees the health service as a business in just the way I suggest that Bill English et al did, so she has to be viewed with mistrust by the mainstream folk who know that it is a social investment and a vital social necessity.

    When medical superintendents were replaced by bean counters, and ward sisters by customer service reps working from algorithms, government was stealthily privatising health care as another business opportunity and had lost the plot. Jacinda Ardern needs to explain why she thinks that tax accountants are better equipped to address people’s health issues than trained medical practitioners are. They’re not.

    • It is an issue of the system then being captured by the professional groups within health, and directing it to their advantage, rather than the wider overall population benefiting.

      • Oh, give us a break Ada. Lovely, convenient theory for disempowering the health and educational professionals, but it was in fact a means for the pernicious middlemen to move in and extract maximum profit to the detriment of supply of health and education to the public.
        You and your ilk deserve public hanging.

    • Snow White there are medical practitioners/HCP’s who see health as a business too. They work in public, get their CME subsidised in public, and then pop down the road to their private business. I would not be blaming everything on bean counters.

      I think the most scrutinised spend in health care is the medicine. PHARMAC analyze cost per quality life year to death, assess this, and assess that, submissiions got to PTAC and sub committees like CaTSOP. Oddly enough they have to (or should be, though Sara Fitt seems reluctant to) fight for every penny they get, or got formerly with the consent of the DHB’s. Strangely though they get, relative to numerous measures, a rather modest sum whereas the rest of the health system has billions thrown at it with what appears to be increasingly poor outcomes (if we focus on the media stories)

    • she went to a source that would provide the ‘advice’ she desired in the 1st place in return for a hefty fee, in effect the pretence of ‘a process’ to cover her original intention as somehow logical or scientific rather than just 2nd hand neo-lib ideology.

  3. I am watching poor old Andrew Little being grilled by Ryan Bridge and I’m thinking: Shouldn’t Jacinda be answering these difficult questions?

  4. One can only hope that setting up a separate health service for and by Maori will improve outcomes. At the very least it should put an end to accusations that poor outcomes for different ethnicities are due to “ racism’ and start looking at the possibility of other causes. Having medically trained persons as decision makers seems a better option than having theorists and policy makers calling the shots, but identically politics seems to deem otherwise, and if government advisers are happy taking their cars to be serviced by pastry cooks then so be it.

  5. What do you expect from a woman with no expertise outside of politics. Everything is political.

    Kindness is just a slogan which the media swallowed completely.
    Well being is a slogan, it would have consumed vast amounts of ministry time while achieving nothing.

    Their only solutions are to go back to the seventies before Rogernomics.

  6. The same can be said about housing, crime etc. The buck rests with the office of the PM, the ministers simply do as they are told.
    Sadly, our PM as the one before them, and the one who will follow them, will be equally shite for the people.

  7. “Prior to becoming prime minister Ardern had minimal understanding of how our health system works.”

    You could swap out “health system” for just about anything else, and that sentence would work just as well.

  8. Another 200,000+ patients on their way…. apparently setting immigration limits and actually having a criteria such as only allowing qualified medical staffed migrants only, is beyond the government.

    The hundreds of thousands of new visas had no age limit, no recent medical limit, applicants and their families did not have to speak English.

    It is hard to fathom why any normal government would push this through after a pandemic when the health and all other systems are in crisis.

    “The number of migrants who have applied for residence under the one-off settlement visa has now surpassed 200,000 people.

    When the policy was announced in September last year, the government estimated up to 165,000 migrants would be eligible in 110,000 applications.

    Those numbers now stand at 202,342 people in 100,508 applications. The discrepancy in the forecasts seems to have been caused by underestimating the average number of people in each application – INZ put it at 1.5 when it advised the government, but it is more than 2.”

    Not just a problem for the medical system, but also the education system with another 14,000 children on their way and half speak no English to hit our schools – our education systems are already failing our current children and have huge truancy already, but the neoliberal globalists, can’t help adding more free load onto the school system.

    Exclusive: Teacher shortage could get worse due to immigration influx

    • National will solve that problem by reinstating their 50 students per class policy of Parata, Key and English.
      National will also solve social housing crisis by throwing motel occupiers back into their cars, garages, caravans, under bridges, back in whanau houses with 15 others, on the streets and elsewhere. Thats where they were when NATz were last in office. The homeless on the streets together with property speculators will be KEYS legacies that we will never forget.

      • I agree, but it doesn’t make what Labeen have done, to the current hospital, GP, nurses, doctors, teachers, right.

        How long are they expected to suffer with NZ politicians and advisors getting immigration wrong constantly and hundreds of thousands of new unnecessary demand onto our systems every year.

        The 200,000+ doesn’t include the tourists and other visa holders so the actual amounts are much higher of new patients on their way… and a lot of the countries these people the government seem to be wanting come from have high pollution levels, high smoking levels, high corruption levels, no English, low expected incomes and a lot more likely to run into health and other problems and thus be competing on the NZ lottery health system.

  9. do pollies have private health insurance, simples….
    don’t put down to stupidity what can be attributed to self interested indifference

  10. Its funny you identify Ardern as being behind this mess. She too features as being firmly behind the law and order mess too. Its was her who appointed Coster as commissioner and doubled down on that with Poto as Minister. Both well out of their depth!

    But dear oh dear, Little is just hopeless!

    • Yes to the point I feel sorry for him but not as sorry as I do for those suffering under his leadership or lack there of.

    • As a worker in the system do you feel well served by Little because as an interested onlooker I feel he is a waste of space and unable to admit the crisis that health is in .
      As a user in Chch I feel for the nurses and doctors who need to leave home at 4 am to get a park and then sleep in the car until their shift starts .This shows the uncaring attitude of those in charge and is there any chance this will change

      • Gosh Trevor you are so correct.
        The very same Andrew Little who championed workers rights?
        The hypocrisy of the supposed left is just horrible.
        John Minto’s latest column sums it up succinctly.

      • Trevor as your question was directed at me and not Bob and given he’s never worked in the health sector, I’ll answer with a degree of experience.
        Andrew Little has just overseen the biggest wage/salary increase to health workers in history. Yes it needed strike action to get to this point, bearing in mind under National wages were frozen for several years. As pointed out in an earlier post administrators have had a $12,000 a year increase! Personally I have had a $6000 a year increase with a lump sum payout of $5400 gross. That’s the financial side of things taken care of. The next issue is staff retention and recruitment of which there is now a massive drive taking place. They can’t just magic staff up( no they can’t Bob) and it will need a significant amount of FTE’s to fill the required number to cover the increase of in our population from 4 mill to 5.1 mill over the past 10 years. The past 10 years of doing nothing to support population growth.
        I am in the same boat as those nurses arriving at 4.00am to get a park. It is infuriating that this infrastructure was not thought of ten years ago when there was unchecked immigration.
        Fortunately the new head of N.Z. Health in our area has strong plans to address these needs, the money coming from cutting CEO’s, consultant and middle management that have had years of sucking on the public tit. This renders your last “statement” irrelevant.

      • There is plenty more I could offer Trevor however I won’t bore you to death, Bob does enough of that for the whole site, simply because Bob is a train wreck, every time he posts.

          • Compared to the bully boy National govt who froze wages and told the unions any strike action would result in layoffs.
            And that fully supports my comments.

      • Bob (straight outta Compton) what does that mean? Because Helen Clarke made a decision over two decades ago, a different bunch under the same party should not change anything? That’s ridiculous

  11. NZers will see a real lowering of the health system for at least the next five years. Maybe for ever no matter who comes to power.

    We are a poor country and we dont have a lot of money to pay for our first world requirements. Outside of defence (which has more or less been done away with), health is probably the most expensive provision we have.

    For years, we have kept it running pretty successfully on the smell of an oily rag and the goodwill of the health workforce. A recession is coming which could perhaps last for a long while and this will affect tax take. After the last few years and the fact that 40% of nurses are dropping out of nurse training, I doubt that we can expect health workers to keep going the extra mile any more and on a below average wage for their skill set internationally.

    Finally once the government does the maths (2022 chaos means we operated at (90%? of ideal) and it saved (x% of dollars) and it only cost us 0.005%? of lives; then you know that they are going to conclude that we can get by on that 90% figure and of course no allowance for increases in population will be factored in. I suspect that what we see as chaos now will quickly become the norm and that we will struggle to ever return to what we thought was the chaos of 2018/2019.

    After all the money Labour has spent recently we simply wont have the money to bring hospitals across the country up to where they need to be. Add in the experiment in Maori Health taking a shit load of money and it will get even worse.

    NB: Not against Maori Health improvement just believe the MHA will end up being ineffective and expensive because it is largely the wrong solution to the problem.

    • My relative was an enrolled nurse and ran a couple of Auckland clinics for one of the Hospitals. She noted how many new foreigners were fronting up for free care plus their families. I think there are 64 different languages needed to be able to communicate. Getting people to turn up for their appointments on time is a problem, and requires reminder phone calls, if they have phones working. I know that I need reminders also, so regular problems like this just multiply and make it hard to run efficiently and effectively. Being sick and poor makes it hard to cope with appointments and treatments and pharmacy needs.

      There has to be some elasticity in the system but with the government having chosen to have large numbers of low-income entrants into this country without the basic organisation, housing etc and proper visa rules, they have set us up to fail. What a shower they all are to use a Brit expression.

    • Unlike Bob, I share your grief and concern, Fantail. Truly tragic, and a similar débacle is not far away in the Education sector.
      I believe that the foundations of this disaster were set back in the times of Roger Douglas and Ruth Richardson. They decided that the market must rule, and that huge profits should be taken by the middlemen, while austerity had to be practised on wasteful social expenditure like health and education..

      We see the results now, and Bob thinks it is good simply because you criticised the current govt.

      Fantail – you are cool. Bob – you are twat of the century.

    • Nope, pensions are the biggest social welfare expense not health.

      And the woke and Natz choose to increase the pension burden, by giving NZ pensions to migrant pensioners who never paid and worked in NZ for much of their lives, and don’t have reciprocal pension arrangements.

      Race based policies in NZ is a big part of the problem and this issue of pensions was known about a decade ago and reported by Grey Power.'-parents-cost-nz-'tens-of-millions‘

      We have a Ponzi of pensioners coming into NZ, and then bringing in more pensioners.

  12. “This inaction was due to a mistaken belief that restructuring would somehow fix things despite evidence refuting this view”

    I can think of about twenty executive boards that would probably be refuting this view, that doesn’t mean they are right. There are plenty at the coal face that don’t think having twenty separate health boards leads to good outcomes and brings in to play a post code lottery (as in your treatment depends on where you live). These healthcare professionals are not EY consultants and implying its only coming from EY is disingenuous. Judging from history the boards don’t seem to have had the leverage to change what has been acknowledged as a mess for quite some time.

    I also recall that the senior leaders in the DHB’s themselves were employing EY’ services (and possibly duplicating the spend) well before Adern became PM. Again I have no idea what the procurement process was for appointing EY in the transition but having being involved for some time might have worked in their favour.

  13. These two almost single handily blocked the safe easy access to medical cannabis.
    They don’t really seem to know much about what would really help this country medically.

    • I am not sure what Arden had to do with medicinal cannabis access. Little on the other hand seems petrified (or may be puritanical) about appearing to do anything with cannabis because of the referendum result. OK the options in the referendum could have at least included just decriminalisng weed, but what a backward arse country in general.

  14. Those rotten DHBs needed to be retired, duplication of functions and admin that could be centralised, personal fiefdoms and unqualified Board Members.

    Health NZ can’t do much worse, but can it do better until the role of the private sector in healthcare is looked at? Patients may have to travel now, but will likely get the care they need in a more timely manner. And the specialist bludgers with the Porsche Cayennes in the carpark should be told to make their minds up rather than straddling public and private sectors.

    • Quite correct Tiger. Attack the health system as it is and attack the new health system before it has a chance. Quite boring really.

  15. What a lot of bullshit from a lot of uninformed right wing anti labour hate Jacinda dirty politics disciples. I have been a regular user/patient to Auckland and Greenlane hospital in the last 3 years and I have had no long waits problems with treatments or care. Its a political beatup for point-scoring. Ryan Bridge appears to be a dumb uneducated nerdish journalist who doesnt do his homework and is just aping his hero Chris’ (Luxon) political snollygoster. I suggest he grows back his man bun, and be more liberal and outgoing instead of a conservative boring tory nerd. He has prematurely turned into a grumpy old man – probably has a photo of Chris Luxon on his mantlepiece. Melissa also needs to do her homework sometimes to understand topics she questions about. The right wing always fins some disgruntled grumpy moaning right winger to support their arguments.

    • Yep, I have had good care too that I cannot fault on two occasions in the last several years, but I know many who have not–my partner included, who had to play off a Surgeon’s timeframe for her hip op against the Admin booking clerk’s 1 hour later timeframe! The Surgeon prevailed, but it was a lot of emails and phone calls to get there. In the end the Whangārei DHB contracted out hundreds of hips in a “job lot” to the local private Kensington unit.

      As my old union colleague Rob Campbell said on RNZ this morning, DHB services are not a lottery because in a lottery the odds are the same for all! Which is obviously not the case for people needing healthcare.


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