GUEST BLOG: Ian Powell – Commissioner’s approach to healthcare provision: ‘slash and burn’
Dr Robin Youngson, a trauma therapist these days but previously a specialist anaesthetist and leader in promoting patient safety published a 5 December piece under the blunt heading Cost cutting a stressed health system only drives up costs – and Health Commissioner Lester Levy knows that. The full piece can be read on LinkedIn:
Dr Robin Youngson calling a spade a spade (NZ Doctor)
It is worth quoting his final conclusion about Lester Levy:
He’s a smart man and he knows that his actions are driving a broken system deeper into crisis. He understands that cost cutting and sacking thousands of staff will actually increase costs and further damage the system….
So what is Professor Levy’s motivation? If he was a man of integrity who actually cared about the public health system, how would we expect him to behave? Not by his disingenuous claims to protect the ‘front line’ of healthcare while finding new ‘efficiencies’.
‘Slash and burn’ in health systems
Dr Youngson has called a spade a spade. While not disagreeing with his conclusion I believe the spade can be further defined as inherently erratic and, in part consequentially and in part inevitably, ‘slash and burn’.
Workforce slash and burn the strategy for Health New Zealand
The origin of this expression is to be found in agriculture. It is a widely used method of growing food in which wild or forested land is clear cut and any remaining vegetation burned.
The resulting layer of ash provides the newly-cleared land with a nutrient-rich layer to help fertilise crops.
When applied to health systems, however, only the first sentence has some relevance. The reference to ‘wild or forested land is clear cut and any remaining vegetation burned’ can readily be replaced with ‘workforce’.
But there is no equivalent for ‘growing food’ or ‘nutrient-rich’ fertiliser reference. It is the health workforce that provides the value, quality, innovation and productivity of health systems.
This workforce is the ‘food and the nutrient-enricher’ of health systems. Slashing and burning workforce is, in agriculture, equivalent to slashing and burning food and fertilisers. In health systems it is the ‘workforce’ which is being burnt.
Slashing IT workforce by nearly half
Few things enable health professionals more than good information technology infrastructure. One of the biggest failures of our health system over several years has been dysfunctional and inconsistent central government leadership over maintaining and upgrading IT systems.
So what is Commissioner Lester Levy’s response; arbitrary staffing cutting without first reviewing the functions of these positions.
Good practice would have been to first start with functions – their relevance and; if still relevant, the number of positions needed to perform them. However, good practice is not Health New Zealand practice!
Commissioner Levy’s ‘slash and burn’ approach
Among the various Te Whatu Ora recent rounds of staffing cuts is the decision to reduce the staffing level of its the Data and Digital group by 47% (1,120 positions) in order to save between $90-100 million.
This is not the only IT cut. It follows the $330 million IT cut announced in the 2024-25 budget last May.
The ‘good news’ is that Health New Zealand’s National Public Health Service is only being cut by 24% (358 positions). Pity about the whooping cough epidemic this service is having to deal with!
Slashing IT workforce means slashing IT projects
Radio New Zealand investigative journalist has reported on this IT slashing. On 10 December he highlighted the consequential axing of more than 100 IT projects:
Health NZ’s plan to stop or defer 136 IT projects | RNZ News
In total, 136 IT projects are to be either stopped or deferred. These include upgrades to improve booking systems and staff rosters, and upgrades in gynaecology and radiology technology.
One major project on the list was an upgrade of Windows 2012 operating systems. This technology lost support from Microsoft’s free updates and bug fixes a year ago.
Cyber security experts have warned such systems were impacted by thousands of common vulnerabilities and exposures.
Meanwhile New Zealand Doctor journalist Steve Forbes has focussed on the impact on primary care in a paywalled 28 November article.
Dr Bryan Betty warns about major risks to primary care connectivity
Forbes quotes general practitioner and Chair of General Practice New Zealand Dr Bryan Betty as warning that:
We’ve got major issues in data and digital in terms of data collection and data connectivity across services and if we want to increase productivity in the health system and become more efficient in what we do, data and digital is critical to that.
Likely ‘slash and burn’ beneficiaries
Highlighting the u-turn nature of this IT ‘slash and burn’ Pennington also noted that Health New Zealand had spent more than $160,000 training five very senior managers recently, including the chief of data and digital, only to then disestablish their jobs.
An earlier Phil Pennington report (29 November) highlighted the erratic nature of this slash and burn approach.
He revealed that, prior to the decision to slash Health New Zealand’s IT workforce by nearly a half, the organisation had spent $72 million on contractors and consultants for a single IT project:
The reality of slashing IT staff and increasing dependence on external IT contractors and consultants (Parton, NZ Herald)
Consistent with Dr Youngson’s warning that Commissioner Levy’s cost cutting will drive up costs, it is most likely that, along with increasing clinical risk and compromised patient care, its gutted IT workforce capacity will lead to Health New Zealand having to engage more expensive external contractors and consultants.
Health New Zealand’s Christmas present to staff
As if to remind everyone that gutting digital health is not enough it has just announced (12 December) that hundreds of positions are intended for disestablishment in two other Health New Zealand units.
These are the 1000-strong procurement supply unit and the 500-strong planning, funding and outcomes unit. Again these cuts don’t follow a rigorous review of functions. NZ Herald cartoonist Emmerson nails it well:
Health New Zealand’s Christmas grinches
I am in no doubt that the above-mentioned critique by Dr Robin Youngson is right. My only doubt is whether he has underestimated how right he actually is!
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
Once again a telling review from Ian Powell.
When you here the Minister of Science making stupid cuts to research, when you here that the PM is in no hurry to have a Chief Science Advisor, when you here Casey Costello is using information from a mysterious unknown source for her decision making, when you here Simian Brown making road safety decisions that fly in the face of proven facts, when you here him talk about building roads to increase productivity in the face of projected negative return on capital, when you hear Shane Jones and Bishop denigrating the environment, when you hear the new Commission for the environment is going to be led by a lawyer with no environmental credentials who could not even run the Rugby Union, when you see a Finance minister cancelling major projects with no idea of what’s next while giving tax breaks to rich people,
WHY WOULD YOU BE SURPRISED THAT A LUNATIC WHO HAS A DUBIOUS RECORD OF MANAGEMENT BE APPOINTED TO GUT THE HEALTH SYSTEM.
This government says they are business focused but show me a business that has improved by slashing staff and facilities and research that has come out better off for itself and it’s customers.
Over the years I have seen and been involved in restructuring of a large corporate 3 times. Each of these restructurings has lead to decreased income, increased customer dissatisfaction, less profit higher than desired staff losses and in the medium term a return to the status quo because they could not provide the service their customers desired.
Health has a product that most of us need and desire. You can only buy it from Government or Insurance owned and operated facilities.
Luxon and his lot obviously want to make Private the first port of call with public as an inferior last resort.
All we can hope is that some Knight in shining armour turns up and sorts this mess out. Unfortunately I do not see this happening until government and media and economist and others lose their obsession with debt as a percentage of GDP.
Someone needs to realise that you cannot and will not achieve increase in productivity in any sector private or public until you identify what level of service is required and is acceptable to your customers and then design a service to provide that level. You then need to staff and fund sufficiently to meet that level.
I believe Levy and co have absolutely no idea of what they need to provide therefore have no idea of funding or people required.
For politicians to demand arbitrary cuts of staff and service to budget some imaginary level of sensible spending is the height of lunacy coupled with arrogance beyond belief and a complete abrogation of the duty they have to all citizens not just their donors.
Unfortunately right wingers only see $$$$ costs not needed outcomes the public required.
This current slash and burn is all about ideology.
With private and public hospital beds and hospitals being cut by around 55% since 1980.
We cant even say any govt even wants privatisation of health services nz.
https://www.facebook.com/share/p/12DUTNnXwqJ/
I believe Levy and co have absolutely no idea of what they need to provide therefore have no idea of funding or people required.
For politicians to demand arbitrary cuts of staff and service to budget some imaginary level of sensible spending is the height of lunacy coupled with arrogance beyond belief and a complete abrogation of the duty they have to all citizens not just their donors.
The above comment is exactly what I think.
This destruction of our health system is all ideological with the closing of 55% of hospitals and hospital beds over the last 40 years in both private and public hospitals you have to ask yourself why? .
What is the end game it sure doesn’t seem to be towards privatisation where you would expect an increase in private hospitals.
SO WHAT IS THE END GAME THAT IS THE ?
GL if we can see this clearly. and have a belief that Kiwis deserve actually need good health practice, and other services, then pollies seeing the destruction wreaked by their fellows must feel excruciating pain. To the few who do feel pain, our sympathies, to the majority of pollies may you receive your just deserts which won’t be sweet.
Also lets not forget the blatant under funding of access to medicines along with the reduction in hospitals and hospital beds.
Add all this up over the last 40 years our health system has been under funded and deprived to the tune of 100s of billions of dollars for what purpose ?
The Commissioner is rearranging the Health system to meet govt targets, such as for waiting lists etc, but mainly to tame the costs of running Health. Cutting staff, and hours, and administration, and resourcing, etc. Waiting list reductions will be achieved by making it ever increasingly harder to even get onto a waiting list, which your GP will know all about, and will tell you that there’s no point even trying to get your hernia or hip or cataracts done, because unless you’ve become completely incapacitated by pain, they won’t be seeing you, for the sake of helping the govt’s KPI’s.
But for all the pitfalls of the public system, it’s probably still better than going through a health insurer middle man, because when you’re gasping for breath, the last thing you want is some insurance actuary, pointing out the fine print, for all the reasons they have decided not to cover you’re heath costs, even though you’ve paid premiums. And there’s no come back if your insurer turns you down, unless you resort to the Mangione alternative complaint redress procedure. The groundswell of support for Mangione, shows just how overwhelmingly American Health insurers are loved, and that Mangione’s actions should not be condoned, even though denying people life saving health care can be just as lethal as a bullet, and kills countless people every day.
Some die for principles, while others die for profits. There are some parallels between the Commissioners motives and Health insurance CEO’s. And thanks to the Commissioner, the American style system is where we are headed, may god or the next election help us, for if your health fails, you can’t rely on the govt and private insurers for help, as they are more interested in clipping the profit ticket, than paying for you in your hour of need. You will know for sure when the American system has truly arrived, for when a New Zealander is in an accident, and the ambulance arrives, the first question will not be: “Are you in pain?” or “Can you move your legs?” or “Can you feel this?” – no the first question from the paramedic will be: “Do you have Health insurance?”
It does all seem to be a big leap backwards, since earlier in NZ’s history there would have been many small hospitals and schools running happily under a more decentralized approach, with no Ministry of Health or Ministry of Education. But there must be advantages to having these big Ministries, otherwise why have we had them for so long?
There has been a disconnect between the hospital and Gp medical files for years .I recently had an alergic reaction to my medication which required treatment at the hospital .The doctor who treated me raised a red flag on my file which my GP never got .And my treatment by the diabetes podiatrist never makes it onto my GP record as well .In these two cases the GP is relying on me to pass on what treatment I have had at those times .My Gp was totally unaware that I had broken my ankle and had plates and screws inserted because the system does not allow that information to be passed on .
So Levy is now cutting the work being done to fix that very problem ,what a short sighted person he must be .He is so obsessed with being able to say LOOK AT ME I CUT 1 BILLION OUT OF THE HEALTH BUDGET ,that he cant see there will be no health system in a short time .This is a case of spend the money now and save billions down the track because we will end up with a more efficient system and faster treatment .
His tack is much the same as no boats Willis ,a knee jerk with no plan for next week .
Exactly.
The north islands IT system is light years behind the joined up IT system the South Island uses.
Thanks to the Efforts of the old Canterbury DHB.
Levy’s dodgy associates are well worth looking into.
Levy is but a tool, he’s not the root of the problem.
The enemy is small government neoliberalism, the most extreme proponents of which in NZ are the ACT and the National Party.
Privatisation of all economic and social activity is and has long been. their objective.
We get what we repeatedly vote for. We keep voting for advocates of neoliberal economics.
Who else? Don’t like any of the flavours in this chocolate box, and the company has been sold to some mega world corpse so ‘ll never get what I like again. And I can’t get fairy mushrooms any more . All good things are up for grabs and downgrading for not much reduction in price, or even surprise! – higher price.