It is difficult to think of something more hazardous in Aotearoa New Zealand at the moment than the parlous state its public hospitals are presently in.
Aside from patients, those most directly affected are their Health New Zealand (Te Whatu Ora) employed health professional workforce.
It is bad enough that this is due the neglect by successive governments of the detrimental effects of the combination of increasing acute demand (growing at a higher rate than population growth) and severe workforce shortages across the full health professional spectrum.
It is bad enough that health professionals face the emotional stress of knowing this neglect is denying so many people necessary timely access to healthcare, both acute and non-acute.
And it is bad enough that this same workforce is paying for this neglect with their personal health, including the effects of fatigue and burnout.
Unadulterated non-stop spin
But, as unbelievable as it seems, this multiple badness is made even worse by the non-stop attempts of their political and bureaucratic leaderships to respond with unadulterated spin in pursuit of damage control from media scrutiny and public wrath.
This disingenuous and demoralising spin continues to be undiluted by empirical expert evidence to the contrary. Or to put it another way, the spin is undiluted by the truth.
In last year’s election campaign National leader Chris Luxon argued that New Zealand’s health system needed more doctors and less spin doctors.
What we have now is the entirety of the system’s leadership transformed into a hyperactive spin machine.
The only redeeming thing for the Prime Minister is that his government inherited it from the previous government. But it continues under his watch and, with the appointment of a Commissioner to replace the HNZ board, it is likely to continue.
Lester Levy’s assurance to Government that budget cuts will not affect health services neither clinically nor financially literate
Lester Levy in this role has assured Prime Minister and Health Minister Shane Reti that the budget cuts (ie, further underfunding) the Government expects will not detrimentally affect frontline health services.
No doubt there has been but it is difficult to imagine a more clinically and financially illiterate statement than this. Financial literacy means nothing without clinical literacy.
News flash to health bosses: cuts already made to misnamed ‘back office’ staffing already have detrimentally affected health professionals at the clinical frontline.
A Northland cancer story
Morning Report highlights two spin stories on same day
The negative impact of this spin on the workforce was brought to the fore by two Radio New Zealand’s Morning Report items, particularly the first, on 2 August.
The first followed coverage in the Northland Advocate of serious concerns raised by local medical oncologist Dr Edmond Ang.
This was picked up by RNZ’s Ruth Hill: Northland cancer specialist speaks out on shortages and spin. For the audio see: Health bosses see numbers, health professionals see faces.
Oncologist Dr Edmond Ang – hypocrisy and spin
Dr Ang began with his frustration over public comment by health system leaders on new cancer drugs and the so-called “faster treatment times”.
However, this would not do any good to his patients because they are already missing out on the basics. He found this nauseating and distressing.
In his words, “What really infuriated me was the hypocrisy and the spin by upper management.”
He was referring to a HNZ statement reported in the Northern Advocate story that “staff vacancies had affected wait times for initial cancer treatments but patients were prioritised based on their clinical urgency, so those more urgent were seen more quickly”.
Dr Ang’s reality was quite different. Northland’s medical oncology team had got the go-ahead to recruit another specialist oncologist last year.
With funding provided for new immunotherapies 18 months ago, money had been put aside to employ new staff to deliver them.
The role was advertised internationally, and after several months, two applicants applied and one was keen. While it was not contested appointment process, it was still considered “a major win” given the severity of workforce shortages.
However, according to Dr Ang, “But then we took that case to upper management, and they disclosed they did not sign off on that position in the first place.” Clinical managers were instructed to make another business case.
Exasperated they did. So what happened next? Again, in Dr Ang’s words:
Unfortunately a few weeks ago we received the final result of all the appeals and all the business cases that we’ve submitted, and we’ve been told that role will not be signed off. And so, that person who we’ve been trying to recruit for a year, has finally taken up a different position.
Management says we’ve managed in the past, and we will continue to manage within our existing resource.
[But] we have to see a patient with small cell lung cancer as soon as possible or they will die, we need to see a young patient with breast cancer early to deliver new adjuvant chemotherapy because otherwise the cancer will become stage four.
We do these acrobatics in our own time, we basically burn the midnight oil and do extras, but we do these things to our peril…
Speaking from the heart
Later in the interview the Northland oncologist really speaks from the heart beginning with the Government’s new target of faster cancer treatment times. This only provide a “a snapshot in time in a really complex process.”
He explains that the target does not capture waiting for scans, reporting on scans, treatments after surgery to wipe out rogue cancer cells lurking somewhere in the body, patient follow-ups, managing treatment side-effects and other symptoms, and all the other parts of the treatment “journey”.
Dr Ang continues:
If we do very well at faster cancer treatment and fail on all the rest of the cancer journey, we are basically failing our patients. And this is my concern – the fixation with the KPIs and big announcements on faster cancer treatments is it doesn’t provide the whole picture.
Further on:
I love my job as a medical oncologist, I care for my patients … if my patient dies, a little part of me dies.
The difference between us and the upper echelons of management is that we see faces.
When I close my eyes, when I try to sleep, I think about the patients who the delays in appointments for treatment [or] for scans have harmed. I think about that and I feel the hurt or the pain they feel.
I don’t think our managers see those faces. They see numbers – but we see people.
We don’t expect them to carry the burden we carry as clinicians. But we just want them to acknowledge us and hear us and support us, rather than trying to obstruct what we’re trying to achieve for patients.
Health New Zealand’s response to RNZ is revealing. It highlighted the enormous gap between those in the isolated bubble of the “upper echelons of management” and those at the patient frontline.
The response did not just repeat the earlier spin about prioritising cancer patients that had cause such offence. It also made an important revelation (arguably confession).
HNZ could not proceed with recruiting another oncologist until its Te Tai Tokerau district (Northland) 2024-25 budget was available.
In other words, recruitment could not proceed because of both existing under-budgeting and uncertainty over whether this would continue into the new financial year. This is despite the desperate patient need for recruitment to be actioned.
Doctors assuming orderly, maintenance and cleaner duties
The second Morning Report item was by RNZ journalist Kate Green and involved Hutt Hospital’s emergency department: Hospital doctors told to make beds and clean sinks. It also included an audio clip: On top of busy patient workloads.
Green reported that Hutt Hospital doctors were being asked to make beds and clean medical equipment, on top of an already busy patient workload.
They were expected to clean, among other things, commodes, hoists and patient washbowls, as well as beds, lockers, soap dispensers, sluice sinks and biohazard bags.
One doctor is quoted as saying:
One shift I made seven beds, answered a million phone calls, and fixed the printer. Is this a really good use of my time? I suspect I’m the most expensive person there.
Hutt doctors were confronted with increasing workloads and HNZ slow to replace staff when they resigned. There were a number of vacancies that had yet to be approved for replacement/
HNZ’s spin was to deny any such changes to doctors duties despite email evidence seen by Radio New Zealand to the contrary. The journalist also personally witnessed one of these duties being performed.
Time to stop the spin
Health Minister Shane Reti must instruct HNZ to stop the spin
Early in the above-mentioned Morning Report Northland oncology item Dr Ang spoke of his infuriation with the hypocrisy and spin of HNZ upper management. In the audio clip he ended with a plea for this demoralising spin to stop.
Overworked and fatigued medical specialists and other health professionals working in very stressful and injurious circumstances and knowing the harm being done to patients is bad enough.
But to then have those with much less accountability diminish their concerns and anxieties with calculated spin is terrible.
Dr Ang has captured this frustration well. If the Government wants to respect health professionals coping with extraordinary pressures imposed on them, then Health Minister Dr Shane Reti needs to instruct his Commissioner to stop Health New Zealand’s offensive spin.
Health New Zealand not only needs to be supporting its workforce; it needs to be seen to doing so.
Bridge the gap between the “upper echelons of management” and those at the patient frontline; don’t widen it.
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
This is so typical of modern management practices today.
I worked for a large company with several manufacturing sites around the country. Never once did an engineer or some other supposed expert from head office come to us and say “how can we help you do your job better”.
Ian – One way of improving the Health NZ Board outcomes is to allow only qualified and experienced medically trained persons on the board…that would remove about 2 to 3 members of the current Board.
Dr Ang’s comment re “the fixation with the KPIs” is sadly were things are at, and not only with the health system. It is the kind of thinking that focuses only on what can be counted, as if this is what really counts, and then uses this to express expected outcomes. That’s current modern management practices for you. And as for the spin, well, what’s happening in the health system is indicative of almost every other area where political and bureaucratic leadership has a central role. What a waste of human and capital resources in pursuit of obfuscation.
the race to the bottom continues at an increasing pace.I expected much better from Levy ,but clearly he has been sent to the dungeon and brain washed and taught how to spin .
Levy just another spin doctor breaking Luxon’s promise of more doctors and not spin ones.
Appalling decision by Levy to defer the Holidays Remuneration ACT payments because of his cuts, payments that are owed because of miscalculation. This is not salary negotiations but simply another “freeze” on entitlements.
Mr Levy, you have let your profession down simply to appease your master.
You are a disgrace and as such should be named and shamed.
Oh and just to be clear, the consultants required to oversee the payments have been let go.
sack ALL the comms/pr staff every single one, what does a dhb need paid liars(yes that is their job) on the health budget for.