A Quiet Health New Zealand Resignation That Speaks Volumes

Saturday, 3 August 2024, 7:01 pm
Opinion: Ian Powell

From when I began my over three decades as Executive Director of the Association of Salaried Medical Specialists (ASMS) I gradually got to know many capable health journalists.

In those very early days there were two that made a particular impression on me, especially in respect of primary care.

The first was a young health reporter for the Otago Daily Times, Barbara Fountain.  The other was a more experienced journalist, Carmel Williams, who edited NZ Doctor. Its main readership was and still is general practitioners and primary care.

Williams possessed an impressive intellect and good journalist professionalism. She appreciated the many ASMS media statements from as the union gradually built up our public profile. I valued and learnt from the relationship.

She left in 1996. After various interesting positions, including achieving a PhD, she is now Executive Editor of  Health and Human Rights Journal at Harvard, Boston.

Her successor was the then still young Barbara Fountain. Fast-forward around 28 years she is still there, albeit ‘non-old’ rather than young. Our collaboration was a lengthy one.

Over that time she assembled an impressive team of quality journalists who shone a penetrating light on the infinitely variable features of primary care and the politics wrapped around it.

A journalist’s nose

One of Fountain’s journalist ‘catches’ was Martin Johnston. I knew him through ASMS as a professionally rigorous health reporter with the NZ Herald for many years. ‘Investigative’ could have passed as his middle name.

Johnston has a nose for what is behind a particular headline story. In this case the headline story was the resignation of Dr Jeff Lowe from the Board of Health New Zealand (Te Whatu Ora).

Dr Lowe is a vocationally registered (specialist) GP based in the Karori Medical Centre in Wellington. Prior to his appointment to the Board he was the Chair of General Practice New Zealand (largely comprising primary health organisations).

He quietly resigned his Board position on 16 July, long before his term was up. This action was about a week before Minister of Health Dr Shane Reti announced he was replacing the now depleted board with a commissioner, Lester Levy.

I had anticipated the appointment of Levy in an earlier Otaihanga Second Opinion post (26 May): HNZ Chair appointment could define credibility and direction of health system leadership. I did not, anticipate however, that the Board would then be replaced with a commissioner.

Levy had commenced his Board Chair role on 1 June so Lowe was well-placed and smart enough to comprehend the approach the former would take even before Reti’s commissioner announcement.

I have discussed the commissioner announcement in a wider context in a Radio New Zealand Nine to Noon interview (23 July): One man now in charge of public health system and in my Newsroom opinion piece (26 July): All powerful Levy.  

Jeff Lowe is a doctor who, more than many, sees the benefit of working within the system to improve it as much as one practically can (and more) and without compromising underpinning ethical values.

This is what made his resignation particularly striking compared with those other former Board members. On 1 June there were only three members left (including Levy) and, with Lowe’s resignation, that left only two before the sacking of the Board.

It took a lot for Lowe to take this step and it took Johnston’s intuitive nose to dig deeper in a NZ Doctor paywalled article (1 August): Primary care destined to go backwards under cost-cutting agenda.

Cutting to the chase

Dr Lowe cuts to the chase. In the context of the politically driven new direction under the new Commissioner he shares his anxiety that “My fear is primary and community care will go backwards under this process.”

Lowe was one of two medical doctors on the former Board. The other was Dr Curtis Walker, a Palmerston North based renal specialist and former Chair of the Medical Council.

On 31 July the NZ Herald reported (paywalled) Dr Walker’s strong criticisms of Prime Minister Chris Luxon’s unwise public accusation that the former Board was financially illiterate: Prime Minister’s accusation personal and baseless disinformation.   

Disagreeing completely, Walker described Luxon as upping  “the ante on their disinformation” to create an excuse to replace the board with a commissioner. Dr Lowe response to Johnston was: “I concur with most of what Curtis Walker said.”

Further, Lowe added:

I have never worked with such a high-powered board before. You don’t have people who either ran IRD for 10 years or turned around and restructured Air New Zealand without some financial literacy.

He was referring specifically to former Board members Naomi Ferguson, a former chief executive and commissioner of Inland Revenue, and Vanessa Stoddart, who was Air New Zealand’s people and technical operations chief for nearly a decade.

Ironically the new Commissioner’s claim to financial literacy is not compelling. I discussed this in my above-mentioned Newsroom opinion piece and an earlier Otaihanga Second Opinion post (20 August 2021): The luck and comings of Lester Levy.

Even more ironical, back in March, Minister Reti had appointed Roger Jarrold to the Board for a three year term. In July Jarrold was sacked as a result of the Commissioner appointment.

But Reti had appointed Jarrold precisely for his financial literacy which was well-known within the health sector. Reputationally, within the health sector, he trumped Levy.             

Clinical literacy versus cost saving

In his NZ Doctor interview Dr Jeff Lowe made a further pertinent observation levering off Luxon’s financial illiteracy slur. He questioned the “clinical literacy” at the top level of Health New Zealand which is now significantly reduced:

Whilst they may have cast aspersions on the financial literacy of the board, I do wonder about the clinical literacy…of the proposed way ahead.

Further:

My concern now is that with the agenda of savings in the hospitals that we no longer have an opportunity of reform, and that window will now be closed. All the concentration will now be on hospital and specialist services, so my fear is primary and community care will go backwards under this process.

If we want to work towards a system that’s inclusive of general practice and primary care being part of the solution, we need to first stabilise the hospital and specialist services system.

Until that happens, I think a health reform where we become far more one system working together will not be realised.

Dr Lowe clarified his resignation. In his own words: “The agenda now is about cost savings. That was not the agenda that I signed up to and [I] did not feel I could play a useful role in that.”

In my words…

In my words, this cost cutting agenda fails to recognise the relationship between financial and clinical literacy.

The former depends on understanding the latter. What makes good clinical sense in health systems also makes good financial sense.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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