On 4 July Stuff published my opinion piece on the angry behaviour of Minister of Health Andrew Little in publicly disparaging dedicated people and organisations strongly committed to the provision of accessible quality healthcare: Health Minister’s angry behaviour denying the obvious.
I referred to his derogatory comments on the “nominal leaders” of primary care (essentially general practice representatives), rural general practice ownership, New Zealand’s pharmaceutical purchasing agency Pharmac, Waikato emergency medicine specialist Dr John Bonning (also President of the Australia and New Zealand College of Emergency Medicine), and finally the NZ Nurses Association (NZNO).
Continued attacks on nurses
Little’s public attacks on NZNO on behalf of nurses have continued. They are based on conscious misrepresentation rather than misunderstanding in claiming that NZNO had reneged on a pay equity agreement for DHB-employed (now Health New Zealand) nurses. The health minister knows full well that this was an agreement between the two negotiations subject to ratification.
Andrew Little continued to attack nurses union
NZNO’s ratification process is democratic based on involved a membership ballot. Following its report back to nurses of the details of the proposed settlement, it quickly became clear to NZNO that, such was the strength of the negative membership feedback, it would most likely be rejected in the ballot. Consequently NZNO focussed on trying to fix the issues behind the negative feedback.
This is what I would have done if I were in NZNO’s difficult position (at least I hope so). But, rather than appreciating the predicament and working with NZNO to sort it out, Andrew Little opted for aggression and distortion. The inevitable effect is to further escalate tensions between nurses and government.
From crisis to catastrophe or carnage
All this is in the context of a wider workforce crisis in hospital and community healthcare which this government, after nearly five years in office, has to assume much of the responsibility for. It did inherit a workforce crisis in October 2017 from the previous National led government. But the current government can no longer dine out on this.
The government’s obsession with health restructuring meant that it took its eye of the ball. The consequential neglect of workforce has meant that crisis has worsened to ‘beyond crisis’.
This became extreme when it opted to restructure the health system in the middle of a worsening pandemic, along with a predictable worsened winter flu. The result was create additional havoc for health professionals and patients. Incompetence at best!
The consequence of this obsession was discussed in my last Otaihanga Second Opinion blog (8 July): Health system now beyond crisis. Now words like catastrophe and carnage are coming part of the language of exhausted health professionals at the clinical and diagnostic frontline.
Journalist Andrea Vance makes a devastating critique of government’s health system performance
This is the context in which the earlier (26 June) Sunday Star Times column by Andrea Vance should be read. It is a no-nonsense critique of the government’s performance focussing particularly on the current health minister, who she reports health professionals describing him as Dr Do Little (ouch): Dr Do-Little: healthcare staff are at the end their rope with the government. I would describe it as chickens coming home to roost.
However, perspective is required in respect of the minister. This government has been in office for nearly five years but Little has only been minister for less that two of these years. This government inherited but neglected the workforce crisis in 2017; Little inherited this neglect but continued it.
For full context, while the government focussed on restructuring at the expense of workforce, health ministers have not been the main driver of this approach. This has been Prime Minister Jacinda Ardern.
She decided the appointment of Ernst & Young senior partner Stephen McKernan to head the restructuring transition unit. Further, it was her call for this unit to be based in her department.
From anger to duplicity
Andrew Little has attempted to respond to the daily frustrations of health frustrations in an opinion piece published by the NZ Herald (18 July): What health minister Little wants for healthcare services.
The good thing about his opinion piece is that he manages to resist making derogatory comments by organisations and individuals in the health system. He does refer to the nurses pay equity dispute but not provocatively.
There is some empathy that appears genuine to the predicament of the health workforce. He does use a ‘c’ work to describe the state of the workforce but it is not crisis (or catastrophe or carnage); his word is ‘chronic’. Andrea Vance used yet another ‘c’ word; collapse.
Nevertheless, much of the opinion piece is embellishing self-congratulatory political spin. No surprises here and not unique to this health minister. But, towards the end of his piece, he resorts to outright duplicity with the following claim:
With our health reforms now in place, we’ve finally got the opportunity to work together to build a workforce that not only meets our healthcare needs but also provides satisfying and worthwhile careers for the people who work in it.
What he is doing is accusing the now disbanded district health boards (DHBs) for causing the workforce crisis. This is grossly unfair. Since the formation of DHBs the overall responsibility for the health workforce rested with the health ministry with bodies set up for that purpose. Further, DHBs don’t determine their funding necessary to employ staff; government does.
Replacing DHBs with Health New Zealand is little more than a repositioning and further centralising of bureaucracy (and those who work in this bureaucracy). Both the chief executive of HNZ and the chair of its workforce group are former DHB chief executives. Most of HNZ’s other senior positions are being taken up by former DHB chief executives and other senior managers.
There is good logic behind these appointments because they know how the health system works. But let’s not pretend that it is anything more than repositioning and centralising.
The health minister’s switching from being angry to being duplicitous does not improve the situation. Instead it means continuing loss of workforce trust and confidence in the minister.
So what happens when a health minister loses the trust and confidence of the health professionals that keep the health system going in such turbulent times and at the cost of their own health?
The minister becomes damaged goods. In other words, dead minister walking.
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