Gutting Specialised Health Teams Follows ‘slash And Burn’ Strategy

Wednesday, 22 January 2025, 3:23 pm
Opinion: Ian Powell

In my final post for 2024 (15 December) I critically discussed the ‘slash and burn’ strategy of Health New Zealand (Te Whatu Ora) under its Commissioner Lester Levy:

Slash and burn strategy for health IT

My post focused largely on how this was impacting on health information technology. Health IT is indispensable for the ability of health professionals to provide timely and safe quality patient care.

In the post I included reference to investigative reporting of this issue by Radio New Zealand journalist Phil Pennington.

Two days later there was another penetrating Pennington piece taking the issues further in discussing a report on how existing IT faults in Health New Zealand’s IT infrastructure were likely to “snowball”:

Snowballing health system IT faults .

Leaking and organisational dysfunction

Now (10 January) Stuff’s persistent health reporter Rachel Thomas has exposed another casualty of the Commissioner-led ‘slash and burn in The Post

Gutting Health NZ specialised health service teams .

Aside from the substantive issue (discussed below) a striking feature of her report is that it is the result of whistleblowing. Severe dissatisfaction and concern expressed internally has been leaked publicly.

This dissatisfaction and concern was based on the well-founded belief that their advice would not be listened to by those in charge. Hardly surprising given past experience!

The Post was leaked an anonymised internal chat and audio from a meeting with staff in the Planning, Funding and Outcomes Community and Mental Health team in December.

Well before her article was published, and well before Levy’s controversial appointment as Commissioner, it was already widely known that Te Whatu Ora was leaking like a sieve.

This is one of the most telling signs of a dysfunctional organisation. The dysfunction is due to its decision-making processes being vertically centralised and consequentially becoming ‘command-and-control.

The inevitable outcome is that its professional workforce loses confidence (if not total, close to it) in those in top leadership who call the shots.

This is not the first Te Whatu Ora restructuring (in fact, the organisation has been in a constant state of restructuring since its formation in July 2022).

No surprise then that it already had a pre-Commissioner reputation for dysfunction. What has changed since the appointment is that this state of affairs has been compounded.

Earlier poor restructuring process .

Putting form before function

What significantly shapes the culture of an organisation, such as Te Whatu Ora, is what comes first; ‘function’ or ‘form’. To be successful function must come first because it directs the purpose of strategies and actions which then enable to the form to be sensibly developed.

But, when form comes first, the process degenerates to activity for activity’s sake and poor decision-making. It is a prerequisite for ‘slash and burn’.

Although putting function before form is an ABC of competent decision-making, at the core of the problem facing Health New Zealand’s latest proposal is that it is putting form first (not for the first time).

The leak to The Post reveals that Health New Zealand is planning to axe around 200 non-clinical jobs in maternity care, children’s health and sexual health. This includes in areas where the Government had specific strategies for improvement.

Axing expert roles in women’s, sexual, oral, rainbow & youth health (Te Whatu Ora)

Its relevant professional staff in, or working with, these teams believe this will “slash crucial expertise and make health outcomes worse.”

Further, “They [HNZ bosses] are putting the cart before the horse by sacking the people and then figuring out what programmes they are keeping.“

Compounding increasing staff frustration is witnessing senior managers struggle to clearly answer their questions.

This is tough on those senior managers who are the messengers. They are not responsible for the message which comes from Commissioner Lester Levy’s cost-cutting mandate. It is tempting, but unfair, to blame messengers for the message in these avoidable circumstances.

As Thomas reports one frustrated manager observing , “We have to deliver the work with less people… not mentioning specific things doesn’t mean that we’re not going to be doing them.

An ‘explanation’ for the proposed disestablishment of these expert teams with “generic” roles. Thomas quotes a biting analogy in response to this argument: “you would not employ five generic surgeons before discovering you needed a specialised cardiac surgeon and didn’t have one.”

Axing, axing, and even more axing

One of the expert teams targeted is dedicated to maternity, pre-conception and early years of life. It would lose 20 full-time positions with the rest of its staff merged with another team focused on older people.

This is despite the fact that this team’s work is part of the Government’s Child and Youth Strategy.

Among the targets of the proposed cuts is a new rheumatic fever team. Such is the importance of this team is that it regularly reports to the Minister of Health.

Another expert team to be disestablished is responsive for developing a HIV plan which was an initiative in the 2022 Budget. However, this plan “no longer has a [national] team to implement it” within Health New Zealand.

There’s more

The above-mentioned cuts to expert teams were not the first of this kind. On 20 December The Post reported the intention to disestablish a small focussed national Health New Zealand palliative care team. The article included the strong critical reaction of palliative care experts:

Experts slam palliative care oversight restructure .

Nor were the proposed cuts reported by Rachel Thomas the last for Health New Zealand. On 16 January, Joel Maxwell described in The Post public health experts slammed plans to cut population health staff:

Chopping with a scalpel by gut feeling .

Political leadership failure

As reported by Rachel Thomas, relevant cabinet ministers, then Health Minister Shane Reti and Mental Health Minister Matt Doocey, along with Associate Health Minister Casey Costello, have unimpressively hidden behind a received assurance from the leadership of their national bureaucracy.

That is, they say, the proposed changes “will not impact Health New Zealand’s ability to deliver on priority areas” where these expert teams are up for disestablishment.

These cabinet ministers have forgotten one of the critical concerns of the Health Simpson review of the health and disability system. That is, the health system was not nationally cohesive enough.

What is being done under the political oversight of Ministers Reti (now Simeon Brown) and Doocey (and Costello) is enabling the health system to become even less cohesive. Opposite direction no less!

© 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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