GUEST BLOG: Ian Powell – Surgeons College exposes false narrative that frontline services don’t depend on ‘back office’ functions

A false narrative is a commonly held belief that is based on incorrect or incomplete information. Often, false narratives refer to incorrect knowledge passed throughout a community or society.

Sometimes false narratives are because the narrators believe the truth feels unsafe. The truth might lead to detrimental repercussions from being shamed to physical harm.

Andrew Little’s verticalisation of the health system inevitably led to an enhanced command-and-control leadership culture

In health systems false narratives often come into play when the leadership culture is, directly or indirectly, command and control.

Under former health minister Andrew Little Aotearoa New Zealand’s health system became highly verticalised; a prerequisite for the strengthening of a top-down command-and control leadership culture.

This culture is conducive to arbitrary decision-making which, in turn, is conducive to decision-making errors. False narratives come into play to prevent the truth from being known. They are not inadvertent.

It can also lead to health system leaders disingenuously covering up the already known or predictable negative consequences of a particular decision with a false narrative. This was definitely not inadvertent.

A false narrative of this type is the bedfellow of ‘spin doctoring’ which I discussed in a recent blog (10 August): Stop the spin doctoring.

Disingenuous false narrative

It is a disingenuous false narrative that is used to rationalise Health New Zealand  (Te Whatu Ora) being required to find $1.4 billion in savings by mid-2025.

Commissioner Lester Levy started his position with an overarching false narrative

Newly appointed Commissioner Lester Levy asserts, without providing any substantiating evidence, that this cost cutting will not affect patient care. He argues that they will only effect so-called ‘back office’ functions.

On the other hand, health professionals say the opposite. They know from their own hands-on practical experience and expertise how integrated these demonised ‘back-office’  functions are with frontline clinical work.

Further, they know from their own experience of earlier recent ‘back-office’ downsizing within Health New Zealand that the clinical frontline was compromised despite bureaucratic utterances to the contrary.

Stuff journalist Bridie Witton: thank goodness for good journalism

Good journalism brings out the truth

Thank goodness Aotearoa New Zealand has some very good journalism. Stuffpolitical journalist Bridie Witton is a case in point.

While she is now covers politics, previously she was an enquiring health reporter for Stuff. However, health is intertwined with politics.

A more specific false narrative: HNZ Chief Executive Margie Apa claims redundancies won’t affect health services

Within the context of cost-cutting $1.4 billion, Witton focused on Health New Zealand’s claim that planned redundancies would not negative effect health services (30 August): Surgeons warn Health NZ redundancies will slow down surgeries.

Witton draws upon Dr Ros Ponchin who chairs the New Zealand national committee of the Royal Australian College of Surgeons.

Ponchin cites her own surgical experience. Usually she does 30 neck surgeries a year at Nelson Hospital. This year she has only done five.

Surgeon Ros Ponchin exposes false narrative

In her words:

Everything is grinding to a halt and it is not just the elective surgeries – even surgeries for cancer are taking too long… it’s not just a shortage of clinicians, including nurses and anaesthetists, or available beds. A lack of support staff – non-clinical roles such as clerks who book clinics – are also having an effect.

Further, the redundancies will have a:

… knock-on effect that will impact the ability to utilise lists and clinics effectively. Redundancy implies these jobs are redundant – they are not.

Ponchin reports the view of her professional college that:

… the loss of non-clinical roles – such as those opened up for redundancy – will effect the frontline because they make it harder for clinicians to do their jobs. This leads to longer wait times for patients, which could have serious consequences – even if someone was waiting for an elective surgery.

Giving another example the surgeon said she had performed three surgeries to fix a person’s hernia this year. Normally these are non-acute procedures.

But, in this case, all three were acute because the patient had waited so long and as a result had to have parts of their bowel taken out.

In response to Health New Zealand’s extraordinary claim that public hospitals had too many nurses, Ponchin retorted:

I am not seeing that. I don’t have enough nurses to operate with, I don’t have enough nurses on the ward.

Political fall guy set up

Previously, when health professionals directly or through their representatives raised concerns about the impact on patients of Health New Zealand’s earlier restructuring and underfunding, Health Minister Dr Shane Reti had a standard response.

This was that Health New Zealand had advised him that this was not happening. As simple and non-enquiring as that.

Health Minister Shane Reti set up to be political fall guy

Now, in response to the same concerns about the new cost-cutting restructuring announced by Lester Levy, Minister Reti has slightly tweaked this standard response.

The response now is that Commissioner Levy has advised him that this restructuring will not affect the clinical frontline; it will not happen. Spot the difference!

The problem is that it is already happening. The College of Surgeons is but one of the reputable bodies saying this.

This false narrative of denying what is happening or obviously predictable has virtually no credibility within the health system.

There will come a time when it will also have no public credibility as well. This will come sooner rather than later.

When this eventuates it will be Minister Reti rather than Commissioner Levy who takes the flak. He will the one who faces the media scrum.

In other words, the Minister will be the political fall guy.

 

 

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