Yes Minister is arguably the funniest British political satire sitcom. There were three series between 1980-84. It was followed by a sequel Yes Prime Minister (1986-88).
The comedy centred largely around the relationship between the fictional Minister of Administrative Affairs Jim Hacker and his Permanent Secretary Sir Humphrey Appleby played by Paul Eddington and Nigel Hawthorne respectively.
The Minister’s private secretary Bernard (Derek Fowlds) was invariably caught in the middle.
One of the most famous episodes involved a newly built hospital. Although it was fully staffed administratively. a government imposed reduction in the recruitment of medical staff meant that there were no patients.
The following brief video clip sums up the hilarious episode: Hospital without patients.
Non-fiction version of Yes Minister: the vertically centralised New Zealand health system way
RNZ Health Correspondent Rowan Quinn: Wow, what a scoop!
Of course, Yes Minister was fictional. Now Radio New Zealand Health Correspondent Rowan Quinn has revealed a believably unbelievable non-fictional similar situation in Auckland (8 April): New hospital building without staff (and patients).
Tōtara Haumaru building (North Shore Hospital): no staff, therefore no patients. How would Sir Humphrey Appleby explain this?
The new four storey building is part of the Health New Zealand (Te Whatu Ora) owned North Shore Hospital and is dedicated for surgery. Around the same size of Taranaki and Southland public hospitals, it was approved in 2018.
The $300 million facility, with eight operating theatres and accompanying wards providing 150 beds, was always intended to be opened in stages.
The first stage – the ground and first floor – was initially supposed to open last December, then this month and now a vague “mid-year”.
Implementation is supposed to be achieved in stages but, so far, there is not even a “rough date for when the entire facility will be operational.”
I’ve also been advised that there are many design deficiencies through squeezed spaces including no breakout rooms. Not even a tearoom!
The good news is that the lights are on, it is the cleanest hospital building in Aotearoa New Zealand, and the patient mortality rate is zero.
Two huge blunders – workforce and operating budget
There are two interconnected huge blunders that stand out in this non-fictional Yes Minister hospital with no patients.
First, there are no staff. This is not just surgeons, anaesthetists and nurses. Absent staff also includes a range of other critical support staff such as anaesthetic technicians and cleaners.
Sitting behind this is the severe workforce shortages that have increasingly plagued public hospitals for well over a decade. Responsibility for this rests with the past neglectful political leaderships of National and Labour-led governments.
This has been inherited by the current National-led coalition government. To his credit Dr Shane Reti is the first health minister to recognise, both openly and explicitly, that these shortages have been (and continue to be) a crisis and the biggest threat to public hospitals.
Health Minister Shane Reti: no visible signs of action over workforce crisis
Unfortunately, there is no obvious sign of him focussing on taking the necessary steps to start addressing the crisis. I have discussed this recently in Otaihanga Second Opinion (2 April): Time for health minister to step up.
The second huge blunder in this embarrassing fiasco is that there is not even a hint of an operational budget to run the new hospital building.
The amount of money allocated to run it for the next financial year (1 July 2024-30 June 2025) has yet to be decided.
To the best of my knowledge this is the first time this has happened in major hospital rebuilds, at least not in the last over three decades.
It makes the vague “mid-year” timeframe for the opening of even the first stage of the building ‘pie in the sky’.
The double-blunder debacle also features in a Newsroom published podcast (15 April) by journalist Sharon Brettkelly: The empty surgical hospital that should be slashing waiting lists—not. The journalist who broke the story Rowan Quinn is also interviewed in the podcast.
Defending the indefensible with a “crock of…”
On 15 April Te Whatu Ora’s local leadership based at the former Waitemata District Health Board forwarded its staff a circular which included the defence of the double-blunder. In its words:
An update on Tōtara Haumaru
Many of you are keenly anticipating the opening of Tōtara Haumaru and would have seen it covered in the media this week.
Tōtara Haumaru was originally planned to open to the public in April. This is now expected to be mid-year.
The go-ahead for the build was announced in October 2018 under the then-Waitemata DHB. In the more than five years since, we have moved to a national healthcare system, navigated the demands of a global pandemic and evolved healthcare services to meet the needs of a rapidly growing and ageing population.
The operation of the facility is being reviewed by Health New Zealand in today’s healthcare delivery environment and with a broader, national lens on how we utilise our facilities.
Work is underway on an operational business case to ensure the most cost-effective approach to opening. The business case will determine the operating budget for Tōtara Haumaru and the initial configuration of staff and services.
As the business case is progressed, we continue to prepare Tōtara Haumaru for its first patients.
The plan is for the building to open in stages with theatres and beds to open progressively as it is scaled-up to full capacity over time. Once we have the right level of work lined up for the facility, staff will come from other areas where planned care work is currently being delivered in addition to recruitment.
We are now well into the commissioning phase with our operational teams focused on getting the facility ‘clinically ready’. Project and operational staff are working hard to ensure that patient, staff and equipment flows work as planned. Construction continues in some areas; primarily on the third floor.
Delivering a project of this scale is a huge achievement and I am keen that we do not lose sight of that. This will be a fantastic asset for our community and in the provision of healthcare regionally. I would like to thank our project management, construction, commissioning and clinical teams for their commitment and collaboration as we work through these final stages.
This long ‘explanation’ is best summarised by a description sent to me by a hospital specialist: “What a crock of crap!!”
Where the responsibility should lie
A white elephant? Time will tell
In an earlier email the above-mentioned specialist described the new building as a “white elephant”.
Despite the above-quoted toe-cringing rationalisation it would be wrong to point the finger at Te Whatu Ora’s local leadership.
Flawed decision-making culture incentivised by former health minister Andrew Little’s health restructuring
The more a health system is vertically centralised, as was done by the former Labour government when Andrew Little was health minister, the more decision-making is concentrated in a small, isolated bubble removed from the operational reality of healthcare delivery.
The command and control leadership culture that this fosters guarantees that the quality of that decision-making will decline and the risk of blunders and debacles increases.
Further, when increasing workforce shortages are neglected to the point of crisis, as they were by previous both National and Labour governments, then the greater the likelihood of hospital buildings without staff (and patients).
In other words, the greater the likelihood that Yes Minister transitions from fiction to non-fiction.
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
Ian – The current CEO of Health NZ is the former CEO of Counties – Manukau Health, NZ’s worst performancing Health District in terms of all outcomes…why promote this CEO?
easy nat, member of the club, they never pay for their mediocrity they’re just ‘transferred’
gagarin – Feels like it
It’s the New Zealand version of the US “wingnut welfare.”
Well, at least there isn’t sewage coming out of the walls! LOL
Good ole National government’s cost savings to thank for that! Not a laughing matter.
“Health Minister Andrew Little said not all neglected hospital infrastructure around the country could be fixed at once, but Whangārei Hospital was close to the top of the priority list.
“With any building, you cannot just let things go and just hope that at some point in the future it will all be alright, because it never is, and we’re paying the price for that historic underinvestment and underspending.”
THIS IS WHY WE NEED LOCALITIES !!!
That Shane Reti has scrubbed.
A MAJOR FAIL in my opinion.
I expect the Christchurch Hospital Riverside rebuild to be similar once its completed.
They are currently remodelling the old A+ E block.
NZ healthcare is in the pits fullstop.
Meanwhile 364 Landlords must have their $2.9 billion debt subsidy.
Jim Hacker had a solution; use the wards as accommodation for a group of people that had no place to live: Cuban refugees I think. Until there is a staff available, the wards should be used for homeless to sleep at nights now that winter is coming.
Andrew Little legacy will take some time to correct.
Andrew Little was the only Health Minister in the past 30 years to support the public sector provision of healthcare. Unlike you who loves the USA system.
Bob the Firsts legacy will be… who is Bob?
THIS IS WHY WE NEED LOCALITIES !!!
That Shane Reti has scrubbed.
A MAJOR FAIL in my opinion.
I expect the Christchurch Hospital Riverside rebuild to be similar once its completed.
They are currently remodelling the old A+ E block.
NZ healthcare is in the pits fullstop.
Meanwhile 364 Landlords must have their $2.9 billion debt subsidy.
Yes Minister was exactly what I was thinking when I first read the story. Fourth comment down in the link below
https://thedailyblog.co.nz/2024/04/08/the-daily-blog-open-mic-8th-april-2024/
They should have kept some scaffolding around (as in the show) then people wouldn’t have realised the building was complete.
https://www.stuff.co.nz/politics/350250767/mental-health-foundation-laying-18-staff-other-charities-also-facing-cuts
And now this Ian.
What say you now Mike King and Sir Ian Taylor both very critical of the Labour government? At least Labour attempted to make things better, National are deliberately making things far, far worse.
National want to privatize healthcare provision in this country.
More Labour Government legacy courtesy of Andrew Little.
More suicides under National.
Andrew Little was the only Health Minister in 30 years who opposed US style healthcare in this country.
Complete and utter rubbish.
Whatever. Every single health minister since the 1990’s have always pushed for the privatisation of health services.
My god Ian, if you thought Little bad you must have thought Jonathan Coleman appalling.
And what was inherited by the last government? they had to fix up a lot of mess it’s a vicious cycle.
Yes perhaps,but they didn’t fix anything,they made things worse.
An ex trade union leader accustomed to getting his own way quit.
Brilliant man, brilliant mind is our Andrew Little.
Very clean — I instantly thought of the Monty Python cheese shop: “Well, it’s so clean.” “Well, it’s certainly uncontaminated by cheese.”
I think I read that the material that went into the Yes Minister and Prime Minister scripts and books was based on reality and a deep and deft understanding of the automatic responses of MPs when faced with common probems. You are seeing a facsimile of what does happen. The writers hung around and immersed themeselves in it and might have come out with webbed fingers for all we know. Perhaps that is what is in the velvet glove that gets talked out FTTT.
A National party legacy, destroy public health to promote privatisation, thank you Jonathan Coleman, worst health Minister in our history. National governments health policies kill.
Fully staffed administratively, but noone to do the actual work it was designed for? It’s not a great exaggeration to suggest that it has become the norm in any number of organisations these days.
Hiring freeze impacting frontline health services
https://www.newshub.co.nz/home/politics/2024/04/health-new-zealand-directs-hospitals-to-restrict-roles-limit-overtime-in-frontline-freeze.html
I can confirm this to be the case in our mental health crisis team.
We cannot do a double shift( as we previously have done) or taken extra shifts when necessary, if our colleagues are ill, a replacement is sort after to cover from another department thus not costing extra but at the same time leaving the other department a person down. This sets a very dangerous president.
Those of us working in health have seen this with a previous National government and one thing all of us that work in health know, Nationals cuts always end in disastrous health outcomes. Staff retention, infrastructure and Healthcare are seriously undermined. Those are the facts despite unqualified comments to the contrary.
2cents.So what will happen?
Either medical staff will be transferred from elsewhere to nice new work conditions but no extra services provided across the city.
Or
Act will fire sell it to a private hospital company for less than build cost.
Longterm.
The writer suggests this has occurred as a result of centralisation. If you listen carefully you can hear bureaucrats, ex-bureacrats, big five accounting consultants, pollies and change agents whispering about the pocket lining necessity for decentralisation.
Cast your mind back to when the Northshore Hospital was built, during Muldoon or Bolger???….they mothballed it….when it finally opened one the first clients (patient) was non other than George Gair whom was the one of the Nat Ministers of Health!