GUEST BLOG: Ian Powell – Health Minister ‘purges’ regulatory health practitioner authorities for carrying out their statutory function

Dr Dylan Mordaunt is a vocationally registered specialist in medical administration, paediatrics and clinical genetics. In recent months he has become a prolific published writer on various health system and professional issues.

Dr Dylan Mordaunt’s perceptive analysis of Health Minister’s ‘sacking’ of Medical Council leadership

On 18 June he published on Substack a perceptive piece on Health Minister Simeon Brown’s decision to ‘sack’ the Chair and Deputy Chair of the Medical Council: When appointments become warnings.

Mordaunt helpfully outlines what S118 of the governing legislation, the Health Practitioners Competence Assurance Act 2003 (HPCA) states as a key function of all the 18 statutory regulatory authorities it established, including the Medical Council:

(i) to set standards of clinical competence, cultural competence (including competencies that will enable effective and respectful interaction with Māori), and ethical conduct to be observed by health practitioners of the profession

With a nice undercurrent of irony and including a clever play on the political influence of the ACT coalition party, Dr Mordaunt observes:

That is unambiguous. Parliament decided to include cultural competence in 2003. Minister Seymour Brown in 2026 decided to sanction the Medical Council for executing its statutory function.

Note his deft reference the political influence of the ACT party in this controversy. As well as ACT leader, David Seymour is deputy prime minister and an associate health minister.

Also note the express reference to ‘cultural competence’ (often also referred to as ‘cultural safety’) as part of the Council’s statutory function.

In the 20 years since the HPCA Act came into force and the 2023 general election this function continued under 11 years and 9 years respectively of successive Labour and National led governments.

I will return to Dr Mordaunt’s further observations on what underlies this controversy towards the end of this post.

The Medical Council in a nutshell

Health Practitioner Competence Assurance Act established regulatory authorities

The Medical Council comprises 12 members. Four are doctors elected by the medical profession (the last election was in March 2024); four are doctors appointed by the health minister as are another four lay members.

Council members elect the Chair and Deputy Chair. The maximum number of three year terms Council members can serve is three.

As required by the HPCA Act, as the regulatory authority responsible for the registration of medical doctors, the Medical Council is expressly independent of government operating under arms-length relationship.

Medical Council required to be independent of and arms-length from government

Reinforcing this independence and arms-length relationship is that the Council is not government funded. Instead it is funded by fees paid by registered doctors.

Successive health ministers of different political persuasions, personalities and capabilities have, since the 2003 Act (and earlier under preceding legislation), respected this independence and relationship.

That is, until 2025, when one Simeon Brown took over the portfolio.

‘Sacking the Medical Council leadership

‘Sacking’ of Medical Council leadership reported by Lucy Xia on Radio NZ

Lucy Xia reported the ‘sacking’ of the Medical Council’s leadership on Radio New Zealand on the evening of 16 June: Concerns over leadership sacking.

She reported that:

The Minister of Health says he has declined to re-appoint the existing Medical Council chairperson Dr Rachelle Love and deputy chairperson Simon Watt when their terms expired, despite both remaining eligible for reappointment.

Dr Rachelle Love ‘sacked’ (or purged) as Medical Council Chair for carrying out statutory duties

Both Dr Love and Watt were previous health minister appointments and were eligible for reappointment for a further term. However, as Xia reports:

A spokesperson for Simeon Brown said the Medical Council had become increasingly distracted by politics instead of focusing on its core responsibilities of improving patient outcomes and ensuring New Zealanders can get the care they need, when they need it.

This left Council members with no option but to elect replacements from their ranks for the two positions.

New Medical Council Chair Dr Ken Clark; highly respected but given a ‘hospital pass’

Subsequently Dr Kenneth Clark (obstetrician & gynaecologist  and chief medical officer at the former MidCentral district health board) and lay member Ming-chun Wu were appointed the new chair and deputy chair respectively. Both were previous health minister appointments by Brown’s predecessors.

Xia reports Association of Salaried Medical Specialists (ASMS) executive director Sarah Dalton correctly described this not only as setting a dangerous precedent in political interference with a regulatory body but also added that:

The minister’s comments and position he’s adopted are borne out of his ignorance of what doctors need to know and what doctors need to do to operate safely and effectively in the New Zealand context.

Further on in the article she noted:

This approach could leave us in a situation where medical standards chop and change with every new government.

It also sends a worrying signal to other regulators: if you don’t do what the minister wants, your people will be replaced.

ASMS was not alone among the professional and union medical bodies. The Minister’s decision was also strongly criticised by the Council of Medical Colleges, College of General Practitioners, College of Physicians, and Resident Doctors Association.

Health Minister’s justification

As reported by Lucy Xia, Simeon Brown’s reported defence for the ‘sacking’ was that the Medical Council was being distracted from focussing “…on improving the timely delivery of health services that New Zealanders expect…”

NZ Doctor journalist Alan Perrott also reported the decision the same day in a paywalled article: Minister’s move sparks fury. He published a second article, also paywalled, the following day (17 June): Minister unrepentant on purge.

Health Minister Simeon Brown uses erroneous claims to falsely accuses Medical Council leadership of pursuing an “ideological agenda”

Simeon Brown claimed that the Council was pushing an “ideological agenda”. He based this accusation on its current consultation documents, including its draft statement on Hauora Māori (Māori health and wellbeing) which was issued on 24 February.

What is “cultural competence’

Alan Perrott reports the forthright criticism of the health minister’s accusation over cultural competence by former Medical Council Chair (and kidney specialist) Dr Curtis Walker who described the ‘sackings’ as a “purge” that was both “dangerous and dystopian”.

Former Council Chair Dr Curtis Walker calls a spade a particularly dirty spade

After stating that “I have never lived under a regressive government in this country” Dr Walker went on to say that Minister Brown’s justifications were dangerous because:

…it’s politicians directly inserting themselves into the professional standards that the profession sets for itself.

Standards that are carefully considered, evidence-based and produced in consultation with the profession and the public. 

As they have done with puberty blockers, this is politicians making clinical decisions, and that is incredibly dangerous and authoritarian. 

He argued that cultural safety is central to clinical care:

…and it applies to everyone. It doesn’t matter whether they are Māori, Pacific, old, young, rural, or whatever religious background or gender identity, it’s between the patient and the professional. 

Professor Jenny Carryer: cultural competence critical to effective healthcare

The fullest explanation on cultural competence during the controversy that burst following the Minister’s ‘purge’ came from within the nursing profession.

On 18 June The Post published a paywalled opinion piece from Jenny Carryer, Professor of Nursing, Massey University: Cultural safety critical to effective healthcare.

This is where the issue of cultural safety becomes critically important. A person’s ethnicity, sexuality, religion, migrant experience, socio economic status and more influence how they consider health, how they manage their health and how they engage with the health system.

Cultural background influences health literacy and underpins significant belief systems including how they engage with screening, vaccination and immunisation. If a person has limited health literacy or different beliefs and practices, they may leave a clinical encounter with little or no understanding of what is needed to both manage their condition and participate in their ongoing care.

In such circumstances the time of both the clinician and the patient is wasted.

When we teach health professionals about culturally safe practice, we are asking them to become sensitive to those differences and to ensure that their awareness influences the way they communicate and what they communicate.

Cultural safety training alerts health professionals to the power differential inherent in clinical encounters and increases their sensitivity to the needs of the person in front of them.

Who is responsible for what

As discussed above the Health Minister’s justification for the ‘purge’ is that the Medical Council has distracted itself from “improving patient outcomes and ensuring New Zealanders can get the care they need…”.

The above-mentioned Dr Curtis Walker pointedly disputes this claim:

Those are not core responsibilities of MCNZ. I’m pretty sure they’re instead something to do with the minister of health… 

Pae Ora Act is clear: responsibility rests with Health Minister and its agencies

He is 100% correct just as the Minister is 100% incorrect. What Simeon Brown refers to comes under the Pae Ora (Healthy Futures) Act 2022 whose overriding purpose is make quality health care accessible for everyone, no matter who or where they are.

The Minister of Health of the day, along with the Ministry of Health and Health New Zealand, is where this responsibility unambiguously and explicitly resides.

Again, as discussed above, the Medical Council is created and governed by the HPCA Act, not the Pae Ora Act. While not opposites to each other, their prime purposes are fundamentally different.

The primary purpose of the HPCA Act is to protect the health and safety of the public by ensuring that health practitioners are competent and fit to practise throughout their professional lives.

In this context it is important to understand the Medical Council’s key objectives:

• protection of the safety of the public;
• competence assurance;
• regulation of scopes of practice; and
• registration and accountability.

Three recent media reported horror health stories highlight the issue of where responsibility rests. All are the result of the health system leadership failure to comply with its governing legislation.

None of them have anything to do with the Medical Council or any of the 17 other regulatory authorities.

First, the last permanent gastroenterology specialist has now left Palmerston North Hospital, leaving the wider MidCentral region’s digestive health needs in the hands of locum and temporary specialists. The hospital is supposed to have six such specialists.

Second, Waikato Hospital’s emergency department was reported as being swamped by patients. A nurse with 18 years of experience in the department described it as the worst day of patient overload that she had seen.

Third, the subsequent tragic and traumatic death of a patient in a toilet at Waikato Hospital’s emergency department that continues to attract publicly expressed concern .

Other regulatory authorities affected by ‘purging’

The ‘purge’ of the Medical Council is not an action confined to this one regulatory authority. The authority covering the largest health professional workforce is the Nursing Council.

Since September 2025, Simeon Brown has replaced eight sitting members. The effects include, reducing the number of Māori representatives from six to one, and the number with nursing experience from seven to four.

But there is more. Last year the Nursing Council held an election for nurses to elect their own representatives to the Council. Not only have the results yet to be announced but the Minister has backfilled those positions with his own appointees.

The regulatory authority for psychotherapists is the Psychotherapists Board. Perhaps mindful of the Minister’s actions in respect of the Nursing Council and his hostility to cultural competence, the entire Board membership resigned thereby preventing their own ‘purge’.

Absorbing Kathryn Ryan interview

This extraordinary event is covered in an absorbing Kathryn Ryan interview with the President of the Association of Psychotherapists, John O’Connor, on Radio New Zealand’s flagship Nine to Noon programme (18 June): Mass resignations.

Meanwhile the Midwifery Council is experiencing some of its own members being replaced by Ministerial appointments who were not recommended as suitable by the Ministry of Health.

Further insights from Dr Dylan Mordaunt

I began this post with observations by Dr Dylan Mordaunt from his 18 June Substackpiece. His piece digs deeper than what I selected for my introduction.

He begins by describing the Health Minister’s ‘sackings’ as a kind of constitution change that isn’t called a constitution change; it is actioned quietly below the radar. But those in the health system fully understand the message.

The constitutional change is much more than about ‘cultural safety’. Instead it is a shift away from professional regulators being arms-length from government and from patients being “…protected by standards that do not swing with the ideological weather.”

Dr Mordaunt notes that the Council’s consultation on cultural competence, cultural safety and hauora Māori may deserve criticism:

Standards should be clear. They should not require doctors to confess political sins or recite fashionable language. They should regulate professional conduct, communication, judgement and safety. They should not become a loyalty test.

While agreeing that a regulator that writes “unclear standards can chill doctors” (just as surely as a Health Minister can “chill regulators” I would add) that is precisely why they consult with doctors; to put it another way, to remove the “chill”.

Health & Disability Commission’s code of rights consistent with cultural competence

Appropriately so, Mordaunt records that the Health and Disability Commission Code of Rights gives consumers (patients) rights to respectful services that take account of cultural, social and ethnic needs, including Māori needs; to services of an appropriate standard; and to effective communication.

Further, the Pae Ora Act “…speaks of equity, culturally safe and responsive services, and a representative workforce. And the Government’s own Policy Statement on Health 2024-2027 includes a skilled and culturally capable workforce.

In Mordaunt’s words:

The policy problem is therefore not “culture versus patients”. Culture is “what we do around here”. Culture is one of the ways patients experience safety, trust, explanation, consent and follow-up. The problem is how to write standards that are rigorous enough to matter and restrained enough not to become coercive.

That is why the method of intervention chosen by the Minister matters. If the draft guidance was poor, the Minister could have submitted to consultation. If the Council was underperforming, the Act contains review, information and audit mechanisms. If the Government wants to narrow cultural competence obligations, it can amend the Act.

Further on he points out that:

Ministers have every right to criticise regulators. They also have a duty to be accurate, evidenced and proportionate, because their office gives their words institutional force. On the evidence, the minister was not only inaccurate, he has sanctioned the Medical Council of New Zealand for executing their core statutory function- not by intent, not interpretively, but by statute.

Then he makes this powerful assessment:

The danger is not only what happened to two people. It is the signal sent to every regulator: do not set standards the executive dislikes. That is not consumer or public-centred government. It is standards by appointment threat.

Finally Dr Mordaunt concludes:

Cultural competence should not become an oath of political loyalty. Ministerial appointment power should not become a quiet weapon against statutory standards.

Ideology and scapegoating by whitewashing

Health Minister using whitewashing to enforce ideology and for scapegoating

According to the Cambridge Dictionary a meaning of the term ‘whitewashing’ is “an attempt to stop people finding out the true facts about a situation.”

It is the tenor, rather than the specific wording that is behind Health Minister Brown’s endeavours to enforce his narrow mono-cultural ideology and to unfairly scapegoat the Medical Council and other regulatory authorities.

ACT MP Todd Stephenson actively promotes regulatory authority purging

Brown is not acting in isolation. Consistent with ACT’s political ideology MP Todd Stephenson is in overdrive promoting the purging of regulatory authorities.

But this does not mean that Brown is being pushed; he and Stephenson share the same ideological DNA on this matter at least.

The ‘purging’ impulse currently underway should be seen in the context of the health minister’s determination to intervene in the workings of the regulatory authorities.

I discussed this in an earlier post (11 February): Minister’s political interference threatens health and safety of public.

I referred to the Minister’s signalling last September arguing (without any evidence provided) that ‘red tape’ by the regulatory authorities was failing to put patients first and amending the HPCA Act was therefore necessary.

The key features of his September announcement included:

• health regulators would be expected to follow many of the planning and reporting standards used by Crown agencies, including statements of intent, performance and output measures;
• the health minister would be able to appoint a committee to independently review registration decisions without having to go to court; and
• the health minister would be able to issue policy directions to health regulators, to help meet politically determined health targets.

Simeon Brown’s lack of support for health professionals expressing opinions on health matters suggests predisposition against regulatory authority independence (Murdoch, Sunday Star Times)

Subsequently Brown took a paper to Cabinet a paper seeking approval to introduce a parliamentary bill amending the HPCA Act to ensure that:

…regulation aligns with patient needs, health system policy and Government targets.

Further, Brown:

…proposes amendments that would bring regulatory authorities (RAs), such as the Medical Council, under the Crown Entities Act 2004, enabling the minister to “direct an RA to give effect to Government policy.”

If the health minister succeeds…

If he succeeds in incorporating this agenda into legislation political interference in what would no longer be independent and arms-length regulatory authorities would be legitimised. Further, he will undermine the prime purpose of the HPCA Act – public safety.

In the 2023 election campaign Christopher Luxon promised to lead an evidence based government but forgot to inform Simeon Brown

When he was transport minister Simeon Brown demonstrated a simplistic approach reduced speed limits arguing that they were “anti-car ideology”. In a 17 June Spin Offarticle senior writer Hayden Donnell revealed research that in fact they saved lives: Saving lives isn’t ideological.

The tragedy is that he is now bringing this narrow ideological thinking into Aotearoa New Zealand’s health system. The biggest loser would then be the safety of the public.