From when I began my over three decades as Executive Director of the Association of Salaried Medical Specialists (ASMS) I gradually got to know many capable health journalists.
In those very early days there were two that made a particular impression on me, especially in respect of primary care.
The first was a young health reporter for the Otago Daily Times, Barbara Fountain. The other was a more experienced journalist, Carmel Williams, who edited NZ Doctor. Its main readership was and still is general practitioners and primary care.
Williams possessed an impressive intellect and good journalist professionalism. She appreciated the many ASMS media statements from as the union gradually built up our public profile. I valued and learnt from the relationship.
She left in 1996. After various interesting positions, including achieving a PhD, she is now Executive Editor of Health and Human Rights Journal at Harvard, Boston.
Her successor was the then still young Barbara Fountain. Fast-forward around 28 years she is still there, albeit ‘non-old’ rather than young. Our collaboration was a lengthy one.
Over that time she assembled an impressive team of quality journalists who shone a penetrating light on the infinitely variable features of primary care and the politics wrapped around it.
A journalist’s nose
One of Fountain’s journalist ‘catches’ was Martin Johnston. I knew him through ASMS as a professionally rigorous health reporter with the NZ Herald for many years. ‘Investigative’ could have passed as his middle name.
Johnston has a nose for what is behind a particular headline story. In this case the headline story was the resignation of Dr Jeff Lowe from the Board of Health New Zealand (Te Whatu Ora).
Dr Lowe is a vocationally registered (specialist) GP based in the Karori Medical Centre in Wellington. Prior to his appointment to the Board he was the Chair of General Practice New Zealand (largely comprising primary health organisations).
Health Minister Shane Reti announced Commissioner to replace Te Whatu Ora board
He quietly resigned his Board position on 16 July, long before his term was up. This action was about a week before Minister of Health Dr Shane Reti announced he was replacing the now depleted board with a commissioner, Lester Levy.
I had anticipated the appointment of Levy in an earlier Otaihanga Second Opinionpost (26 May): HNZ Chair appointment could define credibility and direction of health system leadership. I did not, anticipate however, that the Board would then be replaced with a commissioner.
Levy had commenced his Board Chair role on 1 June so Lowe was well-placed and smart enough to comprehend the approach the former would take even before Reti’s commissioner announcement.
Kathryn Ryan interviewed me on Commissioner appointment on ‘Nine to Noon’
I have discussed the commissioner announcement in a wider context in a Radio New Zealand Nine to Noon interview (23 July): One man now in charge of public health system and in my Newsroom opinion piece (26 July): All powerful Levy.
Jeff Lowe is a doctor who, more than many, sees the benefit of working within the system to improve it as much as one practically can (and more) and without compromising underpinning ethical values.
This is what made his resignation particularly striking compared with those other former Board members. On 1 June there were only three members left (including Levy) and, with Lowe’s resignation, that left only two before the sacking of the Board.
It took a lot for Lowe to take this step and it took Johnston’s intuitive nose to dig deeper in a NZ Doctor paywalled article (1 August): Primary care destined to go backwards under cost-cutting agenda.
Cutting to the chase
Dr Lowe cuts to the chase. In the context of the politically driven new direction under the new Commissioner he shares his anxiety that “My fear is primary and community care will go backwards under this process.”
Lowe was one of two medical doctors on the former Board. The other was Dr Curtis Walker, a Palmerston North based renal specialist and former Chair of the Medical Council.
On 31 July the NZ Herald reported (paywalled) Dr Walker’s strong criticisms of Prime Minister Chris Luxon’s unwise public accusation that the former Board was financially illiterate: Prime Minister’s accusation personal and baseless disinformation.
Prime Minister Luxon upping “the ante on their disinformation”
Disagreeing completely, Walker described Luxon as upping “the ante on their disinformation” to create an excuse to replace the board with a commissioner. Dr Lowe response to Johnston was: “I concur with most of what Curtis Walker said.”
Further, Lowe added:
I have never worked with such a high-powered board before. You don’t have people who either ran IRD for 10 years or turned around and restructured Air New Zealand without some financial literacy.
Lester Levy: superior financial literacy unlikely
He was referring specifically to former Board members Naomi Ferguson, a former chief executive and commissioner of Inland Revenue, and Vanessa Stoddart, who was Air New Zealand’s people and technical operations chief for nearly a decade.
Ironically the new Commissioner’s claim to financial literacy is not compelling. I discussed this in my above-mentioned Newsroom opinion piece and an earlier Otaihanga Second Opinion post (20 August 2021): The luck and comings of Lester Levy.
Even more ironical, back in March, Minister Reti had appointed Roger Jarrold to the Board for a three year term. In July Jarrold was sacked as a result of the Commissioner appointment.
But Reti had appointed Jarrold precisely for his financial literacy which was well-known within the health sector. Reputationally, within the health sector, he trumped Levy.
Clinical literacy versus cost saving
In his NZ Doctor interview Dr Jeff Lowe made a further pertinent observation levering off Luxon’s financial illiteracy slur. He questioned the “clinical literacy” at the top level of Health New Zealand which is now significantly reduced:
Whilst they may have cast aspersions on the financial literacy of the board, I do wonder about the clinical literacy…of the proposed way ahead.
Further:
My concern now is that with the agenda of savings in the hospitals that we no longer have an opportunity of reform, and that window will now be closed. All the concentration will now be on hospital and specialist services, so my fear is primary and community care will go backwards under this process.
If we want to work towards a system that’s inclusive of general practice and primary care being part of the solution, we need to first stabilise the hospital and specialist services system.
Until that happens, I think a health reform where we become far more one system working together will not be realised.
Dr Lowe clarified his resignation. In his own words: “The agenda now is about cost savings. That was not the agenda that I signed up to and [I] did not feel I could play a useful role in that.”
In my words…
In my words, this cost cutting agenda fails to recognise the relationship between financial and clinical literacy.
The former depends on understanding the latter. What makes good clinical sense in health systems also makes good financial sense.
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 – Interesting post…lots of good insights…the current board seems to have a lot of solely Political appointments without a firm understanding of medicine.
So Nathan, you mean they probably have legible hand writing and turn up on time (most of the time). Can’t be all bad
Wheel – Not sure they have.
Very good post. Unfortunately, Health sector is very complex and very expensive. After spending gazillions in holiday pay remediation, pay equity, and above average pay increments for clinical/medical staff in one financial year, it is no surprise that the health sector is struggling financially and would have gone belly-up month ago if not backed by deep pockets of the government. Now the chooks have come home to roost!
Benny – Correct…yet, many of those Directors are paid very well to say ‘no’ to Health Boards, and ‘yes’ to Health Minister.
Actually Benny the opposite to what you say would have seen our best and brightest continuing to head off to Australia. Now we are at least comparable to Australian wages. As for pay equity do you have a problem with that? And holiday pay remediation was a result of incorrect payments going back to 2010. Do you also have an issue with that mistake? If not in one financial year, then when.
Of course Government needs to fund this, yet the idiocy of tax cuts and the gazillions spent on this, well, now the chooks have come home to roost with that neoliberal decision.
What we know is that 10 years ago National offered health a .7 % increase. We are where we are now because of those chooks coming home to roost.
A disaster on its way .The focus will be on the 5 main centers and the rest will go to hell in a hand basket .Most dictators end up getting executed ,maybe Lester has just signed his execution as he will be the fall guy for Luxon AND CIGARETTI
Many years ago, when my son was a teenager, he had a job at the local supermarket on the dairy counter. Alongside him was an Indian man who did similar on the veggie counter. However, this guy was a surgeon trained at the Royal College of Surgeons in Edinburgh no less. He could practice in the UK as a surgeon but couldn’t get residency there. Here he could get residency but thanks to the restrictive practices of the Association of Salaried Medical Specialists he couldn’t practice here. His wife was a similarly trained anesthetist. They worked at the Foodtown for three years, got their NZ citizenship and moved to Aussie where they began working in their profession within weeks of landing.
I am now in need of the help of a medical specialist and am declining in health steadily, week by week. I’ve booked an appointment with an appropriate specialist and am due to see one in April next year. (and yes, that’s going private!) You can imagine my opinion of the closed shop Medical Specialists union.
Your posts over the past indicate you have a closed shop on anything anti right wing or any union of any sort, so no surprise for your negativity towards these specialist but hey, if you think Luxon’s misinformation is right you can always get him to do the surgery, he seems to know the answers on everything.
Andrew. I’m sorry that your health is not good and hope that this turns around for the better. Unfortunately there is a major error in your post. The Association of Salaried Medical Specialists has no role in the registration of doctors in NZ. That is the specific statutory function of the Medical Council which is established under the Health Practitioners Competence Assurance Act. ASMS also has no formal role in the appointment of specialists to salaried positions. Incidentally, to avoid any ambituity. I’m not a doctor.
Yeow Andrew another major error in another of your posts. Rather embarrassing.
The intellectual deficit in Luxon can be seen by the degrading of Air New Zealand under his tenure.
Specialists in the area of health being denigrated by Luxon’s disinformation highlights his inexperience and immaturity.
We as a country are so much worse off that we were under either Ardern or Hipkins.
“I have never worked with such a high-powered board before. You don’t have people who either ran IRD for 10 years or turned around and restructured Air New Zealand without some financial literacy.”
Pretty telling quote that. Basically Luxon is a lair, an idiot or both.
both
Both
Another Clusterfuxon in the making. At least he’s consistent across all sectors.
We have to realise that this govt’s. aims are NOT the same as those of long-standing medical experts or how we would wish our public health system to be run. I suspect they are taking a cynical approach and know full well that this will damage public health and damage the public’s confidence in public health.
There will be a financial reason. The conclusion will be foisted on us without much consultation. Only those who would answer ‘yes’ to privatising health will be asked. Everyone who might say ‘no’ will be sidelined or ignored.
This is not good faith restructuring. They aren’t actually trying to improve things.
Thank-you Dr. Powell for this clearly written article. It leaves one in no doubt about the end result.
Thanks Joy but I’m not a doctor. It’s a common confusion.
Labour had an absolute majority and could have maybe done something about the health system, but as usual just tinkered round the edges. National are stripping the health system, because it fits in with their principles, and the principles of at least one of their coalition partners. Labour did nothing much because they’ve abandoned their principles.
the reasoning of a gorilla .Who gave the nurses 40% pay rises and recruited thousands more and trained record numbers .Major building work at New plymouth Whole new hospital at north shore which this government wont open because they refuse to employ staff .They closed 2 wards in the existing hospital so to make it appear they were opening the new one ,but in fact just moved the old deck chairs to the new one .Work at Nelson has been halted and a new building at Whangarei was halted on election night even though work had started and had been funded .New hospital started in Dunedin and your gorilla mentality sees that as doing nothing .All these dick heads have done is lash and burn as much as they can which will move us back 20 years .You need to remember we are now dealing with 5 plus million people .
The reasoning of a bullshit artist. Labour might have done something, but they could have down there done everything if they’d got their fingers out of their arses. My wife doesn’t have a doctor – simple as that. Her GP actually doesn’t have any. And she can’t get into another practice for love nor money. What did labour do about training more doctors? They were promising to do this in their election propaganda. Why was it still necessary you could ask. Because it was a Blairite government might be the answer.
Things don’t appear so bad now with what Labour were achieving compared to the carnage National have created.
As for their principles it seems they are appalling particularly when specialists are not involved in the decision making.
Labour are a class above this lot – and they fucking cared. This lot are fucking dim-witted lightweights.
Great article – Luxon is a fundamentalist and we should all be worried about the direction he is taking this country in cahoots with his COC lightweight idealists – if Winnie still has any spine left he would crash this train wreck already
is anyone on the right waking up to the lemon they’ve been sold yet? fuck this democracy lite bullshit – I want an homogenous political class that is not beholding to the capital class.