GUEST BLOG: Ian Powell – Gutting specialised national health teams as part of ‘slash and burn
In my final post for 2024 (15 December) I critically discussed the ‘slash and burn’ strategy of Health New Zealand (Te Whatu Ora) under its Commissioner Lester Levy:
Slash and burn strategy for health IT
My post focused largely on how this was impacting on health information technology. Health IT is indispensable for the ability of health professionals to provide timely and safe quality patient care.
In the post I included reference to investigative reporting of this issue by Radio New Zealand journalist Phil Pennington.
Two days later there was another penetrating Pennington piece taking the issues further in discussing a report on how existing IT faults in Health New Zealand’s IT infrastructure were likely to “snowball”:
Snowballing health system IT faults .
Leaking and organisational dysfunction
Now (10 January) Stuff’s persistent health reporter Rachel Thomas has exposed another casualty of the Commissioner-led ‘slash and burn in The Post
Gutting Health NZ specialised health service teams .
More excellent health journalism from Rachel Thomas: gutting specialised health service teams
Aside from the substantive issue (discussed below) a striking feature of her report is that it is the result of whistleblowing. Severe dissatisfaction and concern expressed internally has been leaked publicly.
This dissatisfaction and concern was based on the well-founded belief that their advice would not be listened to by those in charge. Hardly surprising given past experience!
The Post was leaked an anonymised internal chat and audio from a meeting with staff in the Planning, Funding and Outcomes Community and Mental Health team in December.
Well before her article was published, and well before Levy’s controversial appointment as Commissioner, it was already widely known that Te Whatu Ora was leaking like a sieve.
This is one of the most telling signs of a dysfunctional organisation. The dysfunction is due to its decision-making processes being vertically centralised and consequentially becoming ‘command-and-control.
The inevitable outcome is that its professional workforce loses confidence (if not total, close to it) in those in top leadership who call the shots.
This is not the first Te Whatu Ora restructuring (in fact, the organisation has been in a constant state of restructuring since its formation in July 2022).
No surprise then that it already had a pre-Commissioner reputation for dysfunction. What has changed since the appointment is that this state of affairs has been compounded.
Earlier poor restructuring process .
Putting form before function
What significantly shapes the culture of an organisation, such as Te Whatu Ora, is what comes first; ‘function’ or ‘form’. To be successful function must come first because it directs the purpose of strategies and actions which then enable to the form to be sensibly developed.
Form should follow, not lead, function
But, when form comes first, the process degenerates to activity for activity’s sake and poor decision-making. It is a prerequisite for ‘slash and burn’.
Although putting function before form is an ABC of competent decision-making, at the core of the problem facing Health New Zealand’s latest proposal is that it is putting form first (not for the first time).
The leak to The Post reveals that Health New Zealand is planning to axe around 200 non-clinical jobs in maternity care, children’s health and sexual health. This includes in areas where the Government had specific strategies for improvement.
Axing expert roles in women’s, sexual, oral, rainbow & youth health (Te Whatu Ora)
Its relevant professional staff in, or working with, these teams believe this will “slash crucial expertise and make health outcomes worse.”
Further, “They [HNZ bosses] are putting the cart before the horse by sacking the people and then figuring out what programmes they are keeping.“
Compounding increasing staff frustration is witnessing senior managers struggle to clearly answer their questions.
Commissioner Levy’s message tough on his senior manager messengers
This is tough on those senior managers who are the messengers. They are not responsible for the message which comes from Commissioner Lester Levy’s cost-cutting mandate. It is tempting, but unfair, to blame messengers for the message in these avoidable circumstances.
As Thomas reports one frustrated manager observing , “We have to deliver the work with less people… not mentioning specific things doesn’t mean that we’re not going to be doing them.
An ‘explanation’ for the proposed disestablishment of these expert teams with “generic” roles. Thomas quotes a biting analogy in response to this argument: “you would not employ five generic surgeons before discovering you needed a specialised cardiac surgeon and didn’t have one.”
Axing, axing, and even more axing
Axing expert roles in redesigning maternity and early years services (The Post)
One of the expert teams targeted is dedicated to maternity, pre-conception and early years of life. It would lose 20 full-time positions with the rest of its staff merged with another team focused on older people.
This is despite the fact that this team’s work is part of the Government’s Child and Youth Strategy.
Among the targets of the proposed cuts is a new rheumatic fever team. Such is the importance of this team is that it regularly reports to the Minister of Health.
Axing expert roles in developing a national HIV plan (The Post)
Another expert team to be disestablished is responsive for developing a HIV plan which was an initiative in the 2022 Budget. However, this plan “no longer has a [national] team to implement it” within Health New Zealand.
There’s more
The above-mentioned cuts to expert teams were not the first of this kind. On 20 December The Post reported the intention to disestablish a small focussed national Health New Zealand palliative care team. The article included the strong critical reaction of palliative care experts:
Experts slam palliative care oversight restructure .
Nor were the proposed cuts reported by Rachel Thomas the last for Health New Zealand. On 16 January, Joel Maxwell described in The Post public health experts slammed plans to cut population health staff:
Chopping with a scalpel by gut feeling .
Political leadership failure
Health Minister Shane hides behind Health NZ leadership assurances
As reported by Rachel Thomas, relevant cabinet ministers, then Health Minister Shane Reti and Mental Health Minister Matt Doocey, along with Associate Health Minister Casey Costello, have unimpressively hidden behind a received assurance from the leadership of their national bureaucracy.
Also hiding is Mental Health Minister Matt Doocey
That is, they say, the proposed changes “will not impact Health New Zealand’s ability to deliver on priority areas” where these expert teams are up for disestablishment.
These cabinet ministers have forgotten one of the critical concerns of the Health Simpson review of the health and disability system. That is, the health system was not nationally cohesive enough.
What is being done under the political oversight of Ministers Reti (now Simeon Brown) and Doocey (and Costello) is enabling the health system to become even less cohesive. Opposite direction no less!
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
I know a person who had been “cut”
Years and years of practical, patient level experience. Years of personal academic effort. Published work in their field. At last in a position to make a knowledge based impact on policy and methodology. Cut. All that slowly accumulated wisdom lost, arbitrarily it seems.
Off to Australia soon.
The whole country was told Dochebag and Cigaretti would be useless, you were all warned.
Ian a bloody good blog blowing up the who Te Whata Ora slash and burn to save so called costs that will cost us 10x more in the long run by this top down run health system.
This Bullshit WAS LABOURS biggest mistake.
It opened the door for National to completely create a dysfunctional health system with their racist gutting of Maori health and all the subsequent departments you mentioned in your blog piece.
How we are going to piece it all back together again and protect our health system from further slash and burn Govts in the future is my greatest worry.
When our health system is now at the door of collapse.
This I will NEVER FORGIVE LABOUR FOR.
Ian a bloody good blog blowing up the who Te Whata Ora slash and burn to save so called costs that will cost us 10x more in the long run by this top down run health system.
This Bullshit WAS LABOURS biggest mistake.
It opened the door for National to completely create a dysfunctional health system with their racist gutting of Maori health and all the subsequent departments you mentioned in your blog piece.
How we are going to piece it all back together again and protect our health system from further slash and burn Govts in the future is my greatest worry.
When our health system is now at the door of collapse.
This I will NEVER FORGIVE LABOUR FOR.
This is one of the reasons I vote green.
Labour didn’t want the health review.
Labour didn’t want the Pharmac review.
Labour didn’t want the Funding model for Pharmac in the Pharmac review.
Then they ditched the Ruth Simpson report and threw it in the dustbin.
Now labour are crying spilt milk as the health system sinks into a mud bath of chaos and dysfunction under a coalition of chaos that they opened the door for.
best take out funeral cover because you will be dying sooner than you think .
That I already have.
Under Labour I was saved from bowel cancer by having my bowel screening and endoscopy for my stomach and my issues are now all sorted. But under national and the CoC brigade I have had a hole in my eardrum for 10 months now and three GP referrals ignored to see ENT at the Hutt hospital, so I am going deaf, and those national fuckers don’t care. Nationals non elective surgery targets are all bullshit when many NZers can’t even get access to see a specialist and then get a much-needed operation. So, this keeps the list artificially lower than it would be, making it easier for the fucken liars to reach their bullshit non elective targets. National did the same thing last time and too many dumb dumb Kiwis haven’t learnt their lesson yet, so we all have to suffer accept the rich. The same goes for the State housing (kainga ora) lists they make it harder to be eligible. I doubt simeon can fix the problems he will just deliver more spin him.
aND AS SOON AS YOU TURN 70 IT GETS WORSE .My GP tells me that when you turn 70 you go down the ramp as far as seeing a specialist or getting a referal for any thing .My diabetes checks have now been moved out to one a year where as it used to be 6 monthly for a start .I guess that is the magic age from the bible ,3 score and 10 .So with another bible basher taking over health that will be the cut off point to save money from now on .After all he has put in place policy to kill and maim more people on our roads in the last year .
Under Labour I was saved from bowel cancer by having my bowel screening and endoscopy for my stomach and my issues are now all sorted. But under national and the CoC brigade I have had a hole in my eardrum for 10 months now and three GP referrals ignored to see ENT at the Hutt hospital, so I am going deaf, and those national fuckers don’t care. Nationals non elective surgery targets are all bullshit when many NZers can’t even get access to see a specialist and then get a much-needed operation. So, this keeps the list artificially lower than it would be, making it easier for the fucken liars to reach their bullshit non elective targets. National did the same thing last time and too many dumb stupid Kiwis haven’t learnt their lesson yet, so we all have to suffer accept the rich. The same goes for the State housing (kainga ora) lists they make it harder to be eligible. I doubt simeon can fix the problems he will just deliver more spin him.
I had no time for Margie Apa because she was simply a mouthpiece at $800,000 a year but Levy has just thrown her under the bus because he does not wish to take personal responsibility for his own failings.
It is always those on the right that blame others, always has been, always will be.
https://www.thepost.co.nz/nz-news/360554723/health-nz-commissioners-wishlist-next-boss-shows-no-love-incumbent
Levy is donkey deep in the shit that is Te Whatu Ora.
She is brown woman so she will be used as a scape goat when he fails His mantra will be ,see I said you cant trust a kaffa .
A comment on my Under funding of Medicines by pharmac Facebook group says it all.
From Cheryl McLeod
The State of the Nation: Health: a topic I have intimate knowledge of, as a Health Professional and a Health User.
For decades Nurses have been advocates for patients care.
We have been notifying the “powers that be” of short staffing putting pt care under pressure .
Statistics have shown ED’s under Code Black more often than not for at least 30yrs. But, nobody “in power” has listened!
Failure to respond to our notifications has resulted in Inaction and putting pt lives at Risk.
This government has further exacerbated the risk, by sacking Healthcare Staff- according to them, Back Office staff/Non-essential Staff!
Well, there is a quintessential problem with NON- Healthcare Professionals making decisions about Clinical matters- THEY DON’T KNOW WHAT THEY ARE TALKING ABOUT!
The Medical Records Staff- non Frontline, but ESSENTIAL to help us Frontline Staff with getting access to up to date records and information in order to make essential decisions about patient Healthcare treatment.
Bookings Clerks, non- Frontline, but without them our Surgery/Outpatient Clinics and Inpatient care falls apart.
CSSD: Central Sterile Supply Department: non- Frontline, but without them Operations cannot occur, equipment cannot be sterilised and reused, so costs rise through the roof and waste becomes an issue amongst other problems!
Telephonists- non- Frontline Staff, but without them, whanau cannot get through to wards, Staff cannot arrange transfers to and from wards to Xray, CT, MRI, Physio, Emergency Staff/Paramedics cannot contact each other about admissions, Nurses cannot contact Dr’s for patients to be reviewed… .
See how NON FRONTLINE Staff help keep a system running? And these are only a few examples of what happens when you remove a spoke from the wheel!
But POLITICIANS have NO idea how it all works!
If you don’t have enough Nurses to care for an appropriate number of patients- Called SAFE STAFFING, you get increased deaths OR decreased Survival/reduced RECOVERY, INCREASED harm!
We have been warning of this for Decades!
But this government ignores us!
Cuts, fires, sacks, freezes, and says “I’m sorted “!
We just want our Healthcare System SORTED!
Simple Simeon isn’t going to achieve this- and YOU are setting him up to FAIL!
I hope he takes you for Constructive.. oh hang on, he can’t, because Brooke Van Velden has put forward a Bill to prevent employees claiming Constructive Dismissal claims!
Puttting the health strangulation architect’s, snakeoil supremo court jester Lester, and no boats Grimace the android abacus, to one side, if hospitals and community care are given more than enough funding needed to make them world class services, is their actually any need for Te Whatu Ora and the MOH and ancilliary pie chart bureaucracys? Health care is important but so is plumbing, and advances in plumbing that provide clean water and septic systems have saved a comparable number of lives to advances in health care, but there’s no minister or ministry of plumbing or layers of plumbing bureaucracy, there are just good plumbers!
Thats why every time it rains Auckland beaches are closed because those so called good plumbers have connected sewage to storm water pipes and into the harbor it flows