Ian Powell – Health New Zealand and its workforce are not ‘on the same page’
If I was to attempt to summarise in a simple soundbite the precarious and deteriorating position of Aotearoa New Zealand’s health system, I may well say that the leadership of Health New Zealand – Te Whatu Ora and its workforce (including but in no way restricted to its doctors and nurses) are not on the same page.
HNZ-TWO needs to be on the same page as its workforce
If I was to be obscure I may well opine that there is too much Health New Zealand and not enough Te Whatu Ora. But more on that later.
According to that authoritative mechanism Co-Pilot, being ‘on the same page’ means:
…that people share the same understanding, information, or agreement about what should happen next. It is commonly used in teamwork, meetings, planning, and communication to ensure alignment.
However, what characterises the relationship between the leadership of Health New Zealand and its workforce is not just the opposite of this, including non-alignment.
Instead it is worse raising the question at times as whether they are in fact in the same book; one fiction and the other non-fiction!
By leadership I mean the health minister, the board and the highest levels of management. There is an important responsibility differentiation, however, between leadership above Health New Zealand and leadership within it.
By workforce I don’t just mean health professionals and practitioners. It also comprises non-clinical staff whose functions better enable clinical and diagnostic staff to do their jobs, including IT, operational service management, analytical and secretarial.
When not having a hiring crackdown is a hiring crackdown
Ellen O’Dwyer covered the hiring crackdown whose existence was denied
On 19 August Radio New Zealand senior reporter Ellen O’Dwyer reported documents confirming that the hiring crackdown denied by Health New Zealand did, in fact, exist: Documents reveal Health NZ hiring crackdown.
The documents were released by the Public Service Association (PSA) which had obtained them under the Official Information Act.
Lester Levy advised Health Minister of hiring crackdown over 17 months ago
O’Dwyer reported that Health New Zealand leadership, including its then Commissioner Lester Levy, had advised Minister of Health Simeon Brown in a briefing in March 2025 that:
…tight controls on hiring staff were crucial to delivering its budget and that recruitment of any frontline worker was only possible with the sign-off of senior executives.
Further:
…strict recruitment rules had been in place throughout 2024/25, and frontline hiring decisions required the sign-off of the regional deputy chief executive.
“This has been coupled with regular close monitoring of recruitment pipelines and the establishment of the HR oversight group. “The expectation is for these controls to remain in place throughout 2025/26.”
Brown was also advised that “…there would be control over clinical safety, so there were no compromises made to services.”
One would struggle to find a health professional in the country who would agree with this unsubstantiated and disproven by experience assertion.
Accurate shooting from the hip
Fleur Fitzsimons shoots straight from the hip and with great accuracy
PSA national secretary Fleur Fitzsimons was on the mark describing this final above assertion as “pure fantasy” saying that:
…roles weren’t advertised or filled for months at a time, leading to chemotherapy services being shut down and stroke patients not getting the regular care they deserved.
Further:
These documents expose that the health minister was aware that our health system was not filling hospital vacancies as part of a deliberate savings plan and that patient care has suffered as a result. It’s scandalous.
Furthermore:
Health New Zealand set up a complex, bureaucratic approval system in order to slow down recruitment and save money, and the minister knew about it.
Later in the article Fitzsimons notes that:
It took six months to replace three neo-natal intensive care nurses in Wellington, a Northland radiologist vacancy sat unapproved for 12 weeks, we saw a regional sonologist vacancy – 28 weeks before it was approved to be filled.
We are seeing a deliberate strategy, driven by Simeon Brown, where hospital vacancies are not being filled, because they want to save money.
The article also reports other examples of avoidable delays and their impact on patient services.
Health Minister’s response
Minister of Health Simeon Brown’s office is reported as saying:
The minister’s position was clear that Health New Zealand ‘must continue to remove unnecessary bureaucracy to ensure clinical appointments are delivered in a timely manner, particularly in geographic locations or services experiencing workforce shortages that are directly impacting on patient care’.
This is a bold assertion and it has to be acknowledged that there has been some devolvement within Health New Zealand.
However, the Minister’s claimed reality continues to not the actually lived experience of those working at the clinical and diagnostic frontline (nor that of those in support roles).
Dodgy nursing data
RNZ’s Phil Smith reports another different page; this time nursing data
Radio New Zealand has a unit called ‘The House’ which covers Parliament. Its editor is journalist Phil Smith.
On 22 August he brought to the fore the different pages of dodgy statistics and real nurse workforce data revealed in parliamentary debate: Dodgy nursing data.
The context was the oft-repeated Government mantra that it had added more than 2,000 extra nurses since it took office after the 2023 general election. It is held up as key evidence of success
Drawing upon research by health economists Drs Jackie Cumming and Bill Rosenberg,Labour’s health spokesperson and former health minister Dr Ayesha Verrall forced Simeon Brown to admit that over 2,000 claimed nurses equalled 54 actual FTEs (Stuff)
In response to the repeatedly sidestepped question “Is it correct that the net increase in Health New Zealand full-time equivalent nursing staff between the quarters ending March 2024 and March 2026 is 54?”
Brown eventually confirmed in Parliament that the answer was yes. Dr Ayesha Verrall did indeed succeed in getting blood out of stone.
The page the health workforce is on (and its leadership isn’t)
One only needs to go to the investigative journalists in the mainstream media for evidence that Health New Zealand’s workforce is a much different and opposite page than its leadership.
Dr Simeon Brown ‘diagnoses’ health system (Emmerson, NZ Herald)
The following examples published since Ellen O’Dwyer’s above-mentioned Radio New Zealand item make this clear:
- RNZ senior journalist Rowan Quinn covered patients left waiting in soiled beds at North Shore Hospital emergency department (24 August): Patients in soiled ED beds.
- In The Post National and Political Affairs Editor Andrea Vance covered thousands of patients at risk of losing their sight because of an “eye-care backlog”: (paywalled; 24 August): Thousands risk loss of sight.
- In Newsroom Marc Daadler revealed a leaked internal report warning of severe South Island Health New Zealand staff shortages (27 August): Severe South Island staff shortages.
- RNZ journalist Penny Smith covered a powerful warning of a severe mental health crisis with staff shortages, including psychiatrists (29 August): Psychiatrist warn of severe mental health crisis.
- Andrea Vance in the Sunday Star Times adapted the phrase ‘canary in a coal mine’, used to describe an early warning system, to the dangerous state of emergency departments which are barometers for the state of whole hospitals (paywalled; 30 August): Canary in ED corridor.
- Ellen O’Dwyer covered some patients facing 24-hour waits at Wellington Hospital emergency department, including reporting the health minister saying this is not good enough but avoiding taking responsibility (30 August): 24-hour ED waits.
- On RNZ’s Nine to Noon programme Ophthalmology New Zealand chair Dr Sonya Bennett revealed that there was a “tsunami” of increased demand with over 125,000 essential hospital clinical follow-ups outstanding including over 36,000 patients waiting 50% longer than the specialist recommended and another over 20,000 had been waiting 100% longer (31 August): Patients going blind.
Getting to being on the same page
‘Dr’ Simeon Brown ‘fixes’ health system (Murdoch, Sunday Star Times)
The above seven articles by themselves paint an extraordinarily poor picture of the state of the health system since the dramatic revelation published by Ellen O’Dwyer on 19 August. There have also been others of similar vein.
What O’Dwyer described was not a regrettable one-off. What is clear is that is that the leadership of Health New Zealand and its workforce were not on just on a different page on this particular occasion.
Being on different pages is a permanent state of affairs; it is business as usual for Health New Zealand. Patients are the biggest losers in this followed by a fatigued workforce doing it best in untenable circumstances beyond their control.
The biggest obstacle to turning around is much less the leadership within the organisation. It at least is more likely to be in the same book as its workforce.
Instead this obstacle is the political leadership that sits above Health New Zealand whose continued response is to both try to shift blame elsewhere and fail to take responsibility for its performance.
Health Minister not just not on the same page as health workforce; he’s in a completely different book
The failure of political leadership is highlighted by Health Minister Simeon Brown’s late notice decision to pull out of giving the customary address to the Association of Salaried Medical Specialists annual conference as reported by Andrea Vance in The Post: (paywalled; 31 August): Brown ducks leadership responsibility.
This exemplifies the failure of political leadership in the health system. Ducking the responsibility of engaging with those who at the clinical frontline dealing with the daily reality of what the state of the health system is really like is more than petulance and cowardice.
It is confirmation that this political leadership is not just on a different page than the workforce. It is worse; they are in different books.
Our health system is led by a Minister who reads fiction while the workforce is confronted with non-fiction.
A timely reminder
What Te Whatu Ora means (weaving strands)
It is timely to remember and learn from what the name Te Whatu Ora actually symbolises; weaving together people, resources, and services to improve health outcomes across the country.
What we have now is the absence of weaving. The more weaving is allowed to grow, the greater the likelihood of Te Whatu Ora’s leadership and its workforce being on the same page and the better our health system will be for all.
This starts with the next minister of health. Just saying!
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.
Ian another well written expose of our failed 21st century health system more suited for the early 1900s.
Simeon Brown along Lester Levy should not be in any position of responsibility for others as their self serving ways are not compatible with any organization that is trying to fix things. No doubt there are others as well however removing them would be a great start.
Spot on Bonnie, why is Brown in this position at all, he is totally incompetent a d should be nowhere near health.
Lester LEVY has failed in every health job he has held in our public health system.
He should never be employed in it again.
Let’s face it – Simeon Brown is only interested in PRIVATISING our health system to provide profits for his wealthy investors, to the detriment of our patients. He nods away, puts on his ‘little boy lost’ face, but continues with his obsession! My dau waited so long for a heart valve replacement that a 4 hour op became a 6+ hour op. Then her cataracts needed doing and she waited [willing to pay] so by the time she was operated on she was “technically blind” in one eye with the other one not that much better. This ex Banker hasn’t a clue. His health system critically lacks back-up staff and he is lucky to have such a wonderful bunch of doctors, nurses et al. At least Labour have a Doctor as their Health Minister! Brown is typical of the calibre of the CoC Ministers – it’s all about them and what they personally wish to achieve – the patients don’t even come into it! Health is not something that should be scrimped on. Brown is another Luxon – a square peg in a round hole! He has to go too!