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Commissioner’s Approach To Healthcare Provision: ‘Slash And Burn’
Dr Robin Youngson, a trauma therapist these days but previously a specialist anaesthetist and leader in promoting patient safety published a 5 December piece under the blunt heading Cost cutting a stressed health system only drives up costs – and Health Commissioner Lester Levy knows that. The full piece can be read on LinkedIn:
It is worth quoting his final conclusion about Lester Levy:
He’s a smart man and he knows that his actions are driving a broken system deeper into crisis. He understands that cost cutting and sacking thousands of staff will actually increase costs and further damage the system….
So what is Professor Levy’s motivation? If he was a man of integrity who actually cared about the public health system, how would we expect him to behave? Not by his disingenuous claims to protect the ‘front line’ of healthcare while finding new ‘efficiencies’.
‘Slash and burn’ in health systems
Dr Youngson has called a spade a spade. While not disagreeing with his conclusion I believe the spade can be further defined as inherently erratic and, in part consequentially and in part inevitably, ‘slash and burn’.
The origin of this expression is to be found in agriculture. It is a widely used method of growing food in which wild or forested land is clear cut and any remaining vegetation burned.
The resulting layer of ash provides the newly-cleared land with a nutrient-rich layer to help fertilise crops.
When applied to health systems, however, only the first sentence has some relevance. The reference to ‘wild or forested land is clear cut and any remaining vegetation burned’ can readily be replaced with ‘workforce’.
But there is no equivalent for ‘growing food’ or ‘nutrient-rich’ fertiliser reference. It is the health workforce that provides the value, quality, innovation and productivity of health systems.
This workforce is the ‘food and the nutrient-enricher’ of health systems. Slashing and burning workforce is, in agriculture, equivalent to slashing and burning food and fertilisers. In health systems it is the ‘workforce’ which is being burnt.
Slashing IT workforce by nearly half
Few things enable health professionals more than good information technology infrastructure. One of the biggest failures of our health system over several years has been dysfunctional and inconsistent central government leadership over maintaining and upgrading IT systems.
So what is Commissioner Lester Levy’s response; arbitrary staffing cutting without first reviewing the functions of these positions.
Good practice would have been to first start with functions – their relevance and; if still relevant, the number of positions needed to perform them. However, good practice is not Health New Zealand practice!
Among the various Te Whatu Ora recent rounds of staffing cuts is the decision to reduce the staffing level of its the Data and Digital group by 47% (1,120 positions) in order to save between $90-100 million.
This is not the only IT cut. It follows the $330 million IT cut announced in the 2024-25 budget last May.
The ‘good news’ is that Health New Zealand’s National Public Health Service is only being cut by 24% (358 positions). Pity about the whooping cough epidemic this service is having to deal with!
Slashing IT workforce means slashing IT projects
Radio New Zealand investigative journalist has reported on this IT slashing. On 10 December he highlighted the consequential axing of more than 100 IT projects:
Health NZ’s plan to stop or defer 136 IT projects | RNZ News
In total, 136 IT projects are to be either stopped or deferred. These include upgrades to improve booking systems and staff rosters, and upgrades in gynaecology and radiology technology.
One major project on the list was an upgrade of Windows 2012 operating systems. This technology lost support from Microsoft’s free updates and bug fixes a year ago.
Cyber security experts have warned such systems were impacted by thousands of common vulnerabilities and exposures.
Meanwhile New Zealand Doctor journalist Steve Forbes has focussed on the impact on primary care in a paywalled 28 November article.
Forbes quotes general practitioner and Chair of General Practice New Zealand Dr Bryan Betty as warning that:
We’ve got major issues in data and digital in terms of data collection and data connectivity across services and if we want to increase productivity in the health system and become more efficient in what we do, data and digital is critical to that.
Likely ‘slash and burn’ beneficiaries
Highlighting the u-turn nature of this IT ‘slash and burn’ Pennington also noted that Health New Zealand had spent more than $160,000 training five very senior managers recently, including the chief of data and digital, only to then disestablish their jobs.
An earlier Phil Pennington report (29 November) highlighted the erratic nature of this slash and burn approach.
He revealed that, prior to the decision to slash Health New Zealand’s IT workforce by nearly a half, the organisation had spent $72 million on contractors and consultants for a single IT project:
Consistent with Dr Youngson’s warning that Commissioner Levy’s cost cutting will drive up costs, it is most likely that, along with increasing clinical risk and compromised patient care, its gutted IT workforce capacity will lead to Health New Zealand having to engage more expensive external contractors and consultants.
Health New Zealand’s Christmas present to staff
As if to remind everyone that gutting digital health is not enough it has just announced (12 December) that hundreds of positions are intended for disestablishment in two other Health New Zealand units.
These are the 1000-strong procurement supply unit and the 500-strong planning, funding and outcomes unit. Again these cuts don’t follow a rigorous review of functions. NZ Herald cartoonist Emmerson nails it well:
I am in no doubt that the above-mentioned critique by Dr Robin Youngson is right. My only doubt is whether he has underestimated how right he actually is!
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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