Ian Powell – Health Minister misses health targets – yet again!!

How many times has Minister of Health Simeon Brown missed the target while frequently undertaking his self-promotion of his highly politicised health targets? For the answer see my final comment below.

I was prompted to write about this largely rhetorical question after a Radio New Zealand Morning Report item on 16 September: Health Minister argues health targets will solve hospital pressures.

Aotearoa New Zealand is fortunate to have such a quality public broadcaster as RNZ to undertake wide-ranging investigative reporting over an ever-expanding range of issues. Although secular it can be argued that it is doing ‘God’s work.’

This is certainly the case with its coverage of our health system, including the positives, but also its exposures of the bad and disingenuousness that is happening. Morning Report has been a particular standout, not to diminish its other programmes.

Exposure

The Morning Report item began by outlining the current pressures that the health system is under threat from, in particular in public hospitals.

When public hospitals are in strive, as they presently are, the implications and risks are not confined to within their walls. For example, general practitioners depend on them for further investigations and more complex treatment) are under.

The programme’s focus is largely on emergency departments. However, they are barometers on how the rest of their hospitals are functioning.

An emergency department in strive means that the rest of the hospital, including inpatient wards, are also in strive.

RNZ’s Morning Report does quality health reporting very well

Specifically Morning Report observed that:

• the health system has been under significant pressure this winter, with Auckland City Hospital saying it’s been worse than expected;
• the previous day Tauranga Hospital emergency department staff had declared a ‘state of emergency’ because it was running up to 200% capacity while understaffed;
• In July emergency department staff at North Shore Hospital reported that they faced chronic understaffing with some patients waiting 50 hours;
• elective (planned non-acute) surgeries have been postponed made worse, but not caused, by surging winter flu;

Dr Dominic Fleisher highlights unacceptable lengthy waits for patients at Christchurch Hospital’s emergency department

• in July Christchurch Hospital emergency medicine specialist Dr Dominic Fleisher commented that while a few minutes delay would be acceptable in the department,  “patients are there for hours overnight”; and
• in August, St John’s director of ambulance operations Doug Gallagher advised RNZ that they were getting a call every 20 seconds, which was not sustainable.

Ministerial misleading: blame the flu

Minister of Health Simeon Brown response was misleading. In his words:

No doubt it’s been a very challenging winter. In fact, it’s been, I think, one of the worst influenza seasons in a very long time with very high levels entering our hospital system, and so it has put the system under significant pressure this winter and our frontline staff have been working incredibly hard to respond to that.

Bed-blocking driven by overflowing patients occurred well before the winter flu outbreak

While this was a particularly severe flu, it is misleading to suggest that this was why our hospitals are overflowing. I discussed this in my previous post (13 September): Hospitals already overflowing well before winter flu outbreak.

Levering off an earlier Morning Report segment (9 September) I commented:

The reality is that our public hospitals have been hit by overflowing at least since 2011. That was when a tipping point was reached; the rate of acute hospital discharges was greater than the rate of population growth.

More and more hospitals were increasingly both reporting 100% or more occupancy and more often.

Compounding this problem were the continuing widespread severe workforce shortages affecting almost all health professional occupations in public hospitals.

‘Bed-blocking’ is less to do with the number of beds and much more to do with the number of doctors and nurses to staff them.

This above-mentioned tipping point of increasing acute demand meant that emergency departments started to become overwhelmed and ‘bed-blocking’ in hospital wards began with acute patients having to take priority over non-acute patients requiring planned procedures.

Erroneous Ministerial analysis: Health targets the ‘game-changer’

Morning Report then focusses on Simeon Brown’s shift from being misleading to completely erroneous when he promotes health targets as the way forward; probably deliberately so.

I have previously written about some of the problems with the Government’s claims about the benefits of its health targets. The two most recent pieces are in Otaihanga Second Opinion (23 June): Health target politics versus clinical prioritisation and Newsroom (18 August 2025): Simeon Brown places health target on patients’ heads.

Health Minister claims his health targets are a game-changer for public hospitals; untrue

Brown argued that his highly politicised health targets were the way forward for ending the overflowing of public hospitals. He affirmed in Morning Report that:

What I expect as minister of health is we want to see year-on-year improvement against all of our health targets, which is what we are seeing. We acknowledge there’s too many people waiting too long.

However, the health targets are not indicators of how well the health system is, or is not, working, particularly public hospitals. Very broadly speaking there are four main categories of care in respect of public hospital:

1. Acute care – can’t be deferred.
2. Chronic illnesses – ongoing treatment required; illness managed, not cured.
3. Planned (elective) – non-acute cases arising out of general practitioner referrals for further investigation.
4. Emergency departments – ideally patients are either discharged or admitted to the main hospital, usually inpatient beds.

If only Simeon Brown was half as good as William Tell at hitting the target

The targets don’t apply to either acute care or chronic illnesses, both of which are high volume.

They do apply to planned care and emergency departments but only things that can be counted.

In other words, much of what is done in public hospitals are not covered by the health targets and what they do apply to is confined to those things that can be readily counted.

The two biggest obstacles to achieving the targets are severe workforce shortages and increasing acute demand. These are discussed in the above extract from my previous blog post (13 September).

Cutting to the chase

Time cut to the chase; time for health minister to listen and learn

I understand the expression ‘cutting to the chase’ originates from early filmmaking, where editors would ‘cut to the chase’ to move quickly from slow scenes to exciting chase sequences. Now it generally means get straight to the point.

If the Minister of Health was serious about turning around the enormous pressures our public hospitals have had forced upon them, he would first do well to drop his embellished politicised soundbites such as those on health targets.

Then he should focus on recognising and addressing the two key problems faced by public hospitals – severe workforce shortages and increasing acute patient demand.

Health Minister Simeon Brown needs to refocus on the key problems (RNZ)

If he was really serious about having a target that if achieved would address much of the intolerable pressures on hospitals. Much of acute care is not easily countable for the purpose of a target. But hospital acute discharges data is readily available.

Acute discharges have been increasing at a higher rate than the rate of population growth since 2011; a tipping point for overcrowded hospitals. They are largely driven by social determinates of health external to the health system.

Solving social determinants of health solves much of hospital patient demand

There is no target for acute discharges because this would require the Government to address these social determinants such as income and housing; something it is not ideologically predisposed to do.

Imagine what could be done if there was a commitment to first bend the curve of increasing acute discharges and then decreasing it.

If this government genuinely believed in the effectiveness of health targets in improving the health system, then why does it not have a target(s) for the main driver of healthcare demand and hospital overflow?

Political or ideological inconvenience by any chance!

So how many times does Simeon Brown miss his health targets? The answer is to be found withing the spectrum between lots of times to all the time. This is me at my generous best.