Mountain Tui: Can we talk about New Zealand’s health system?
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- Date published:
11:25 am, July 23rd, 2024 - 96 comments
Categories: budget 2024, Christopher Luxon, health, Shane Reti -
Tags: Health System, Lester Levy, privatisation
By the time Christopher Luxon and Shane Reti fronted the waiting media throng to announce the disbanding of the Health NZ board, they were already down 5 of the original 7 Directors. I wrote about it here, but the upshot of it is that a few resigned unexpectedly, and others expressed discomfort with the direction of Health NZ under National. One, a former National Party MP, said it was clear she had to leave after the changes she felt Health NZ needed, would not be made.
Yesterday, Luxon and Reti used their old trick of blaming Labour and saying a budget “deficit” was imminent. The only wrinkle is that that “deficit” is caused by National choosing not to realistically fund the health service in their May budget.
Labour’s Verrall had spoken about the challenges before. Nurses’ pay received a bump. Unpaid holiday pay was accruing. Elective surgeries post-Covid had increased. Medical professional hours (nurses and doctors) were up.
National were told of all these pressures in the Heath Select Committees earlier in the year, but Reti appears to have stuck his head in the sand, until Health NZ’s Board was nigh demolished.
Enter the chosen one – Dr Lester Levy, an ex Auckland Transport Chairman and friend of Mr Luxon. According to a Newsroom report, Levy’s style is “top-down, controlling and destructive.” He also championed running health care as a business. This is the new Health NZ Commissioner.
Luxon expressed great confidence in Levy, and made some signals that suggest Te Whatu Ora’s CEO will probably be let go too. He also got fiery as he insisted Health NZ needs to stick to their allocated budget and no deficit was considered acceptable to him and Reti.
Yes, the budget that they screwed the pooch on. I like to remind people that Simeon Brown did the same in transport. Brown’s numbers only blew out by $24bn.
The National / ACT government boasts it is big on health care, even as it systematically breaks our heath care system down.
It funded an extra $1.4bn more in the May budget, and is now demanding that the health care system stop spending to the tune of $1.4bn.
As Labour pointed out, National did a slapdash job on the budget by using pre-election numbers, based on old demographics, and is now “desperate.”
2500-3000 staff are expected to go and “back office” roles in Te Whatu Ora includes information technology specialists, health and safety, policy, research, suicide prevention, cyber security, quality assurance, procurement, scheduling, HR, and appointments.
Meanwhile, where is the real work on addressing our nursing shortages, mental health crisis, GP network, doctors and staff?
I write more about it all in this longer piece, but the real question here is, what is the end game? And what Luxon and Reti consistently fail to recognise is the very real human impact on the ends of all their decisions.
Will the adults in the room please stand up to help?
Mountain Tui writes on political, social, and investigative matters.
96 comments on “Mountain Tui: Can we talk about New Zealand’s health system? ”
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The failure of the Prime Minister to condemn his Minister for personally attacking the judiciary is another example of this Government riding roughshod over important constitutional rules. ...1 week ago
- Waititi urges Rotorua Lakes Council to immediately stop works at Lake Rotokākahi
Te Pāti Māori co-leader and Member of Parliament for Waiariki, which includes Rotorua, has written to Rotorua Lakes Councillors requesting they immediately stop sewerage piping works at Lake Rotokākahi in Rotorua. “Mana whenua have been urging Rotorua Lakes Council to stop works and look at alternative plans to protect the ...2 weeks ago
- Release: Patient care at risk from redundancies
Patient care could suffer as a result of further cuts to the health system, which could lose thousands of staff who keep our hospitals and clinics running. ...2 weeks ago
- Greens call on Govt to wake up on child poverty
The Green Party says the latest statistics on child poverty in this country highlight the callous approach that the Government is taking on this issue of national shame. ...2 weeks ago
- Release: Police are off the beat under National
Foot patrols around the country have decreased 15 percent since National took office, despite National’s Mark Mitchell claiming otherwise. ...2 weeks ago
- Release: Climate denial is an insult to Pacific leaders
Winston Peters’ climate denialism at the Pacific Islands’ Forum is an embarrassing new low. ...2 weeks ago
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The Labour Party is calling on the Government to tell the two major wealth funds, the NZ Super Fund and ACC, to withdraw investments from companies listed by the United Nations as complicit in Israel’s illegal settlements in the Occupied Palestinian Territories. ...2 weeks ago
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Our environment remains at risk despite the Government's proposed changes to its controversial fast-track legislation. ...2 weeks ago
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- Release: Chris Hipkins’ Speech to Local Government New Zealand
...2 weeks ago
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On the back of a patronising speech to local councils the Government has rushed out an announcement on regional and city deals that leaves out the crucial component – funding. ...2 weeks ago
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The National Government has put the interests of tobacco lobbyists ahead of New Zealanders and their health. ...2 weeks ago
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The Government’s move to enforce austerity measures on councils is an assault on local democracy. ...3 weeks ago
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Minister of Internal Affairs Brooke van Velden says passport processing has returned to normal, and the Department of Internal Affairs [Department] is now advising customers to allow up to two weeks to receive their passport. “I am pleased that passport processing is back at target service levels and the Department ...2 days ago
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- Resource Management reform to make forestry rules clearer
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- Joint Statement between the Republic of Korea and New Zealand 4 September 2024, Seoul
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- Comprehensive Strategic Partnership the goal for New Zealand and Korea
Prime Minister Christopher Luxon held a bilateral meeting today with the President of the Republic of Korea, Yoon Suk Yeol. “Korea and New Zealand are likeminded democracies and natural partners in the Indo Pacific. As such, we have decided to advance discussions on elevating the bilateral relationship to a Comprehensive ...4 days ago
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The Government is moving to review and update national level policy directives that impact the primary sector, as part of its work to get Wellington out of farming. “The primary sector has been weighed down by unworkable and costly regulation for too long,” Agriculture Minister Todd McClay says. “That is ...4 days ago
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The first annual grocery report underscores the need for reforms to cut red tape and promote competition, Commerce and Consumer Affairs Minister Andrew Bayly says. “The report paints a concerning picture of the $25 billion grocery sector and reinforces the need for stronger regulatory action, coupled with an ambitious, economy-wide ...4 days ago
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Associate Education Minister David Seymour says the Government has listened to the early childhood education sector’s calls to simplify paying ECE relief teachers. Today two simple changes that will reduce red tape for ECEs are being announced, in the run-up to larger changes that will come in time from the ...4 days ago
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Regulation Minister David Seymour says there has been a strong response to the Ministry for Regulation’s public consultation on the early childhood education regulatory review, affirming the need for action in reducing regulatory burden. “Over 2,320 submissions have been received from parents, teachers, centre owners, child advocacy groups, unions, research ...4 days ago
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“The Government is empowering women in the horticulture industry by funding an initiative that will support networking and career progression,” Associate Minister of Agriculture, Nicola Grigg says. “Women currently make up around half of the horticulture workforce, but only 20 per cent of leadership roles which is why initiatives like this ...4 days ago
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The Government will pause the rollout of freshwater farm plans until system improvements are finalised, Agriculture Minister Todd McClay, Environment Minister Penny Simmonds and Associate Environment Minister Andrew Hoggard announced today. “Improving the freshwater farm plan system to make it more cost-effective and practical for farmers is a priority for this ...5 days ago
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- Building reliable and efficient roading for Taranaki
A record $808 million for transport investment in Taranaki through the 2024-27 National Land Transport Programme (NLTP) will support economic growth and productivity, Transport Minister Simeon Brown says. “Taranaki’s roads carry a high volume of freight from primary industries and it’s critical we maintain efficient connections across the region to ...6 days ago
- Supporting growth and resilience in Otago and Southland
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- Delivering connected and resilient roading for Northland
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- Government delivering reliable roads for Manawatū-Whanganui
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- Restoring connections in Hawke’s Bay
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- Transport resilience a priority for Gisborne
A record $255 million for transport investment in Gisborne through the 2024-27 National Land Transport Programme (NLTP) will support economic growth and restore the cyclone-damaged network, Transport Minister Simeon Brown says. “With $255 million of investment over the next three years, we are committed to making sure that every transport ...6 days ago
- Prioritising growth and reduced travel times in Canterbury
A record $1.8 billion for transport investment Canterbury through the 2024-27 National Land Transport Programme (NLTP) will boost economic growth and productivity and reduce travel times, Transport Minister Simeon Brown says. “Christchurch is the economic powerhouse of the South Island, and transport is a critical enabler for economic growth and ...6 days ago
- Supporting growth and freight in the Bay of Plenty
A record $1.9 billion for transport investment in the Bay of Plenty through the 2024-27 National Land Transport Programme (NLTP) will boost economic growth and unlock land for thousands of houses, Transport Minister Simeon Brown says. “Transport is a critical enabler for economic growth and productivity in the Bay of ...6 days ago
- Getting transport back on track in Auckland
A record $8.4 billion for transport investment in Auckland through the 2024-27 National Land Transport Programme (NLTP) will deliver the infrastructure our rapidly growing region needs to support economic growth and reduce travel times, Transport Minister Simeon Brown says. “Aucklanders rejected the previous government’s transport policies which resulted in non-delivery, phantoms projects, ...6 days ago
- Record investment to get transport back on track
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Minister for Mental Health Matt Doocey has welcomed the start of Gambling Harm Awareness Week by encouraging New Zealanders to have their say on the next three-year strategy to prevent and minimise gambling harm. “While many New Zealanders enjoy gambling as a pastime without issue, the statistics are clear that ...6 days ago
- JOINT STATEMENT FOR THE OFFICIAL VISIT OF NEW ZEALAND PRIME MINISTER CHRISTOPHER LUXON
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but Reti appears to have stuck his
handhead in the sand"Yes, the budget that they screwed the
porchpooch on"Do we really use “ pooch “, to quote Walter from the Big Lebowski, I think the correct nomenclature dude is rooted the kuri. Either way we are at the mercy of the evil ones.
The RW used to complain of the Greens ‘magical money tree’ but here we have the RW ‘magical efficency tree’ in action . They claim to be able to get the same or even better results with less resources and less cost. Luxon and his “Crew of Clowns” are full of shitand desparately need flushing at the next election!
The Greens independently cost all their budgets because they know they’ll get crucified for the slightest mistake.
There does indeed appear to be a double standard at play.
Unfortunately the ‘magical efficency tree’ is actually a branch torn from the fruitful money tree that the rw zealots beat those below then in the hope that they will proform better.
The floggings will continue until moral improves
How come the new Health NZ needed 2500 extra bureacrats?
A lot of staff were moved over from Ministry of Health at establishment along with some from the Health Promotion Agency which was disestablished and functions folded into TWO, and more recently, Te Aka Whai Ora was disestablished but functions and staff were moved to TWO.
Thanks Craig H. They were moved over but that doesn't mean they were needed.
The Min of Health has hardly covered itself with glory over the Puberty Blockers review. Well over a year and still no report. As Emeritous Professor Charlotte Paul says the report is redundant now after the Cass Review. But still puberty blockers being prescribed in NZ at high levels.
Do you have any facts or evidence the 2500 were all bureaucrats? Shane Reti couldn't even outline the supposed 14 layers – and many health experts have rubbished his claims. I won't wait for your evidence, but it may be useful to seek it in future before making claims.
Re those 14 layers: I simply don't believe them. I've been recalling my time in the UK civil service. When I joined in 1973, the Permanent Secretary (highest rank) was 8 grades above me, and the lowest grade of Clerical Assistant was only two below. And that was in a Department numbering some 2,200 staff in all.
Reti doesn't know either
And based on others’ comments, it’s a rubbish generalisation.
I’m looking forward to the howls of grief from everyone who voted for their tax cuts, wilfully blind to everything that gets traded for them. I have zero sympathy when they need the public health system (not everything is available privately) and it doesn’t exist anymore. Voting has consequences.
We will have to wait and see
I am not sure how many people voted Nats cause of tax cuts, but maybe you have some intel on it.
Why are you looking forward to the possibility that the Health system is going to be in a bad way? Of course no one can rule out that a year after a commisioner, things want run better. I am keeping an open mind
Oh I know it's in a bad way. Unfortunately I have a periodic need for it and have been in close contact with the decline for 30 years. While I used to not wish this on anyone, I've reached the point where there's no excuse for not knowing the track record of whom you vote for, and the consequences that are likely to happen.
It would indeed be nice to keep an open mind as to what may happen, but it's very hard not to be cynical.
Not sure they realise.
Many still think National are mopping up Labour's errors – and that is why the storylines perpetuated by Luxon and co. are based on that myth.
Good point.
The budget overspend this financial year is 1.8% . A great result in anyones language
And the previous year it was 'break even'. Those are the two budgets done under Labour Government.
24-25 year is Nationals accounting and oversight .
National is doing the Starve the beast from the Ruth Richards era
Big Hairy News talk with Ayesha Verrall, over Coalition's Health approach, first 15 min.
Article comment that Levy/Luxon are friends…
…if the governance is changing from a board to a commissioner, has anyone checked to see if an appointment process was followed? Or was it deemed ok to just roll one of the two board members left over and call the other one the commissioner?
Who else was given an opportunity to put their hat in the ring?
Rumour has it that Sir Bill turned it down because of the 12-month period [insert cheeky emoticon]
So not enough graft for bill then…
Sir Bill English seems to only like gigs where there are no field trips and dealings with the body he has to audit:
https://mountaintui.substack.com/p/knives-out-for-kainga-ora
2500 extra back room jobs since the re-structure of the DHBs into NZ Health. That's a hell of a big salary bill. They need to get rid of a lot of this excess and put the money towards front line staff.
On the contrary, the extra money is mainly related to salaries – nurses, doctors, and the holiday pay liabilities.
This is the problem when facts aren't available and most people like you, perhaps, are quick to assume.
Note: You can look all this up on the Te Whatu Ora statements from around March, as well as during the Health Select Committee meetings around that time.
Reti and Luxon spun it so much it doesn't even look like the original cake anymore.
Mountain Tui, the photo header looks like the Unhealthy duo are digging a hole…please jeebus, don't let it be our NZ Health System's grave : (
I looked at your Lester Levy Link…and not having heard of him before…looked further. An interesting Chap. His Wiki page lists….Business leader, adjunct professor, and medical doctor, in that order. Also Chairman of Boards…..
And reading some of his previous Health Interactions, he does seem to have had somewhat of another Doctor in his persona, per Dr Jekyll and Mr Hyde ?
A worry, his close connections with Nats….of all persuasions.
I have been around the Politics watch area for a while..and well remember Tony Ryall….fark !. Also another Doctor…Jonathon Coleman. His plans for Private Healthcare NZ.. were stymied. Although he personally then went off on his own private Health career.
I sincerely hope the present NACT1 cancerous crew…also get stymied.
Keep up the good work Mountain Tui. : )
Cheers! I admit that I thought the photo was prophetic for what they seem to be doing to our health care system, as I outlined in my earlier post.
Before we go all Shane Reti this'n'that, can we have the grace to accept that most of this is on Labour?
Labour controlled the health system, all the DHB's, and all the budgets that they and Treasury produced for 6 consecutive budgets.
Labour generated the reforms, while both dismantling and controlling the remainder of the MoH over 6 years.
Labour completely dismantled the DHB system an its final remainder at democratic accountability to the public through voting representatives.
Labour stopped public reporting of actual DHB facts because it simply illustrated "postcode healthcare" which is another term for regional wealth and wellbeing disparity that it didn't want to hear about.
Labour spent an inordinate amount of time developing a Maori-only health provision arm that just pissed everyone off.
Labour oversaw a positively wretched slide in health statistics on most health disciplines, but really outdid itself on mental health spending where it spent more than anyone before it and managed to move the mental health treatment or outcomes not one iota into improvement.
Labour's cabinet truly showed its poor decisionmaking when its Cabinet stupidly agreed to MoH revisiting the scope and price of the Dunedin hospital, not even realising that agreeing to decreased scope would require a massive redesign that saved them zero money, and in doing so outraged the people of Dunedin that they turned the largest ever single hospital expenditure from a regional triumph into a political gift for National.
Sure National aren't helping. But the health reforms should have been locked and done inside 2 years. Hipkins is fully on the hook for this mess.
all of this.
How much did the Dndn Labour vote drop?
it also raises the issue of tory-proofing.
Agree Ad. Look I am not sure how things are going to go at NZ Health. Lester Levy was around when I worked in health in the 1990s and had an o.k. track record then. I really hope it improves, because we need a better functioning health system
Newsroom
National aren't helping?
Again, National created this "deficit" by specifically underfunding Health NZ's operating needs.
The majority of the difference is health professional salaries, and accrued holiday pay liabilities. Electives are up, and there is salary pressure as nurses leave.
Currently there are about 2500 nursing vacancies.
The real crisis is the system, and not National's reputation, which is all they seem to be trying to protect.
As to the hospitals, Reti put a hold on all the builds and infrastructure investment as soon as he got in – don't you fret about money being spent.
If the real crisis is "the system" as you suggest, Labour designed that system from the ground up.
Are you being intentionally obtuse, or genuinely don’t know what the issues are or what “health system” means?
You get one benefit of the doubt.
And in that vein, this is what the people in the "system" say – you know, those pesky doctors and medical experts the government doesn't want to listen to:
https://www.thepost.co.nz/nz-news/350351801/who-lester-levy-man-replacing-health-nz-board
This is what some some 'experts' in the 'system' said about the DHB reforms:
"Association of Salaried Medical Specialists (ASMS) former executive director Ian Powell told Morning Report patients were likely to be big losers in newly announced health reforms."
"Canterbury DHB former acting chairperson Tā Mark Solomon told Morning Report the news of the reform was "like an atomic bomb being dropped with no warning". He was sceptical of the planned changes."
Health system reform: What the experts are saying | RNZ News
Ad's summary above is as close to the mark as any of the commentary here. The reforms were poorly conceived, poorly timed and poorly executed. Only time will tell whether the latest batch of politicians and political appointments can fix this unholy mess.
Time will tell. No it won't.
You can't undo something that has been in play for a few years while it's optimising and evaluate it. Nor does someone use a 2021 report to evaluate a 2024 condition.
NONE of the doctors and nurses are talking about the operating model were they? They are all talking about funding, and the inadequacy of it – nurses are on record this year as saying people are going to die because of NACT1's policies and austerity measures on health.
No worries if you're a landlord though $3bn didn't even bat an eyelid for Luxon and co.
You can't undo something that has been in play for a few years while it's optimising and evaluate it.
Yes, you can. In fact you have a duty to when the restructure is so clearly failing.
And funding is being used as a smokescreen to cover up that failure. As Lester Levy said (emphasis added):
"He said the $1.3b deficit was "entirely unacceptable, because never before has there been so much money invested into healthcare, never before have we had so many FTEs". He said Health NZ was a big organisation, but in his view it is "totally bloated" with bureaucracy. It would be a challenge to resolve but it would be resolved, he said, and then the organisation would focus all its attention on patients."
'Totally bloated': New Health NZ Te Whatu Ora boss Lester Levy lays into bureaucracy (msn.com)
To support Levy's comments about spending, and generally refute the idea that funding is the problem:
This chart shows per capita core crown spending on health.
Core Crown spending on health in New Zealand – Figure.NZ
In 2008, the figure was $2,662. In 2023 it had risen to $5,512, an increase of 107%. Over the same period, the $2,662 can be inflation adjusted to $3,348 in 2024 (New Zealand Inflation Calculator – MoneyHub NZ).
So since 2008, core crown spending per capita has increased by 65% more than the rate of inflation.
Brilliant analysis, Will! You’ve convinced me that Levy speaks power to truth and will be the saviour of NZ Health. How is it that the good man hasn’t been knighted yet!?
Edit: just as well that I checked that; he was appointed a CNZM in 2013.
Your claims are incorrect.
The data shows an 4.7% annual increase in the government health spending per person on average, after accounting for inflation up to 2007-8 under Helen Clark. Growth reduced by two thirds to a more modest 1.3% over National’s last period in government under John Key and Bill English, but nonetheless growth continued.
If we project using Stats NZ population figures and the reserve bank’s May inflation forecast, the recent budget sees the amount of day to day spend per person on health next year at current prices reduce by 3% to $4,686 per person; $143 per person less in real terms.
The new government’s reduction in real terms spend per person in the next twelve months, and the treasury’s current forecast to remain below 2023-24 levels in real terms per person for the next 4 years, is well below anything achieved this century in New Zealand or comparable countries.
https://www.nzdoctor.co.nz/article/print-archive/follow-money-see-what-budget-2024-spends-health
The figures I quoted are for the period 2008 through 2023. Those figures are not incorrect, unless the sources are.
With respect to the current government, your link is behind a paywall, but the author may be making the same mistake as 'Clint'. I have covered this in my comment https://thestandard.org.nz/they-are-going-to-privatise-health-arnt-they/#comment-2006163.
In the link, inflation since then.
Well that's Verrall's view. But it's not Reti's.
"This is not a matter of there not being enough funding," he said.
"When National and Labour released their strategy for health in the 2023 election, both parties had exactly the same figure – an additional $12.57 billion for Health NZ over the forecast period. National has gone even further and invested a record $16.7 billion in the [three budgets to 2026] for Health New Zealand, plus an additional $604 million for more medicines."
It's politics.
It’s a matter of competency. Reti and Luxon were incompetent to underfund by $2bn. They knew of the shortfall in March and stayed quiet. They only acted after nearly all of the Health NZ board resigned.
A point that even Hoskings hammered Luxon for.
Reti and Luxon were incompetent to underfund by $2bn.
Link?
And a reminder:
“He said the $1.3b deficit was “entirely unacceptable, because never before has there been so much money invested into healthcare, never before have we had so many FTEs”. He said Health NZ was a big organisation, but in his view it is “totally bloated” with bureaucracy. It would be a challenge to resolve but it would be resolved, he said, and then the organisation would focus all its attention on patients.”
https://www.msn.com/en-nz/news/national/totally-bloated-new-health-nz-te-whatu-ora-boss-lester-levy-lays-into-bureaucracy/ar-BB1qrEne?ocid=BingNewsSerp
You’re quoting Levy in 2024 after he got the plush role. I introduced his 2021 cheerleading only for context. His need to praise governments in power is uninteresting.
His 2021 ‘cheerleading’ came with a very big proviso. One he nailed.
By the way, where is your link to the $2bn claim?
The video.
And he didn't nail anything – the funniest thing is you use his quotes out of context as if they amount to anything close to evidence.
Even Hoskings nailed Luxon for a reason on this topic, but please keep defending.
The video.
You're deflecting. You claimed "Reti and Luxon were incompetent to underfund by $2bn.". Where is your evidence for that? I’m genuinely trying to decide whether I’m engaging with someone who has even a cursory understanding of the health system, or none at all.
And he didn't nail anything – the funniest thing is you use his quotes out of context as if they amount to anything close to evidence.
He 'nailed' the fact that the primary source of success is not strategy but implementation.
[The $2bn is in the video – bad faith]
[Will, stop being rude to the author, and slow down and pay attention to what is being said to you. You appear to have missed where the evidence was. You’re in premod for a while – weka]
[it’s looking like you are using a different username than you have in the past. If that is true, then on your next comment you need to choose between Will and the previous name and then stick to it. I’m making a note in the backend. If you change your name again after that, you will be moderated. If you haven’t changed your name, then you can just carry on using Will.
Sometimes people have legitimate reasons for changing their username eg they start a new job where commenting on line is going to put their job at risk. But generally we need people to use one name, not least because it reduces the workload for mods. – weka]
I’d suggest rather than try to troll with attempted gotchas, that you focus on watching the video, and then doing your research. Reti and Luxon confirmed it was true.
And despite your dances around Levy – he championed and cheered Labour’s proposal in 2021.
The one he says now needs to go. Which is ironic, but he definitely sounds like a company man.
Re: your comment about implementation, I don’t mean to be unobservant, but that applies to everything in life e.g if you build a house, the first point is the concept and design, then lies the implementation.
There is no evidence the implementation didn’t work, and in fact, the overrun was due to nurses salaries, pay equity, backdated holiday pay and the like.
These are all clear and present facts for anyone who cares for the facts.
I’d recommend Bernard Hickey’s substack – he wrote a very clear one on the details of it. Or Newsroom articles. Or Bryce on Democracy Project. So many have clearly documented the facts. Even Newstalk ZB had a go for Luxon’s incompetence.
Apparently they realised the coming overruns in March 2024 and pretended they didn’t know, underfunding the healthcare budget and then claiming it was a surprise in July. Hm food for thought.
I suspect your allegations after seeing the video shows a very bad faith approach – when even Reti couldn’t deny it, I can be sure that a supporter who is using points out of context, and dancing around the facts, is the one who is not worth engaging with.
mod note.
I'm sorry Weka, I'll dial it back.
thanks. Can you please look at the additional mod note?
additional mode note. Please reply to my comment here acknowledging you have seen and understood.
Hi Weka. I'll only post here as Will. Thanks.
👍
Guess who said this?
"In my view, the health reforms proposed by Minister Little and his colleagues are the type of change that have all the potential to result in unparalleled progress for healthcare in New Zealand. There are three crucial elements that give me confidence that these reforms can make a transformational difference. Firstly and most critically, they firmly address the underlying root problems rather than the symptoms; secondly, they are bold and comprehensive rather than the more customary tinkering; and thirdly, the disposition of the minister and his colleagues is calm, thoughtful, compassionate but unquestionably resolute. "
Dr Lester LEVY 2021
The reason links are important is so that we can read everything the author wrote. I found the quote here – ‘All my dreams have come true’: Doctors and experts react to the end of DHBs | The Spinoff.
Here's more of what Levy said:
The one unease I do have about this reform process is that when it comes to effective change the primary source of success is not strategy but implementation. The only thing that stands between the future path the minister and his colleagues have so clearly laid out and a successful outcome is the efficacy of implementation.
In reality, the government botched the implementation to such an extent the reforms failed. Levy had that part right.
There is only so much interference one can run on cold, hard facts.
From 2021, it was clear he felt this was a hugely important, transformative step. A warning of risk is not evidence of reality.
And the diversion doesn’t stop the reality that costs were related to personnel costs even as the government claps down on nurse/doctor hires.
Levy was indeed impressed with the proposals. Levy also warned that the primary source of success was implementation. He was well and truly on the money.
The circular logic here is interesting. Refer to Levy here and here but not here but there. And there, and here. Let’s read him here but not there. And there but not here.
Refer to Levy here and here but not here but there.
I haven't done that. And I'd suggest you look up the meaning of 'circular logic'.
The restructure of NZ Health was designed to go through two main stages, with the ambitious timeline of 5 years.
https://www.health.govt.nz/new-zealand-health-system/health-system-reforms/health-system-reform-roadmap
In its typical amateurish slash & burn style, the coalition government is now increasingly underfunding the already chronically underfunded ‘system’. It’s a continuation of its zealous repeal & reject without replacing & reconstructing that shows a shambolic lack of vision, strategy, and leadership. Dr Levy has been planted there for superficial cosmetic surgery, i.e., ripping off a few band-aids, breaking a few noses & jaws, and pulling a few teeth, for the next lot to plaster over.
Hardly, not even all white people.
Lock down major IT reform in 2 years …
You left one thing off your list:
Labour completely dismantled the DHB system directly ignoring the Health and Disability System Review, which recommended a reduction to "between 8 and 12 DHBS within five years of Health NZ being established". (health-disability-system-review-final-report-executive-overview.pdf)
Shocking!
What’s your point?
And something happened after the HDSR was completed, didn’t it?
The point is that trying to migrate from 20 DHB's to none over 3 years was a stupid idea.
Very compelling argument
Guess who was a huge FAN of those reforms?
LESTER LEVY
"In my view, the health reforms proposed by Minister Little and his colleagues are the type of change that have all the potential to result in unparalleled progress for healthcare in New Zealand. There are three crucial elements that give me confidence that these reforms can make a transformational difference. Firstly and most critically, they firmly address the underlying root problems rather than the symptoms; secondly, they are bold and comprehensive rather than the more customary tinkering; and thirdly, the disposition of the minister and his colleagues is calm, thoughtful, compassionate but unquestionably resolute. "
Dr Lester LEVY 2021
Well, I think getting rid of the DHBs was a good idea, my understanding is this was Andrew Little's baby, not Hipkins.
20 DHBs, 20 payroll systems, 20 supplies contracts, 20 IT systems, 20 management systems, 20 HR departments, etc. It made no sense.
But there seemed to be no vision with HNZ how to get there, no person to lead the charge. No idea what, who, how it was all going to happen. If Lester Levy can swing it, who knows, it might work.
As for voting for the DHBs- I never knew who I was voting for, and many of the candidates seemed to just have their little pet project.
Just let the medicos get on with it, for the love of God.
all sorts of problems with voting and local body elections, but the solution to that is to increase democratic participation, not lessen it. We wouldn't remove councils because voting is run badly or to save on payrolls.
We have DHBs because we had Area Health Boards, and before that management with clinical experience running hospitals locally. Might be useful to go back and look at the Area Health Boards and how much that was neoliberal fuckery vs useful to communities, but hospital culture wasn't that great back in the day. All sorts of power dynamics.
People like some local control. The failure of three waters was partly due to people understanding that centralisation harms communities. Resentment starts to dig in deeper over time and can be hard to roll back.
Remember the 10,000 people that marched in the streets of Dunedin when they tried to take away the neurology department and move it all to Chch? Anyone who has lived in rural Otago or Southland knew exactly what that would mean. My own view on health and water is that bods in Wellington do a bunch of really important stuff, but they fail in their inability to listen to the importance of localisation.
"We have DHBs because we had Area Health Boards, and before that management with clinical experience running hospitals locally. Might be useful to go back and look at the Area Health Boards and how much that was neoliberal fuckery vs useful to communities, but hospital culture wasn't that great back in the day."
Yep, couldn't agree more.
This whole blame National, Labour are saints is gonna get us nowhere.
Labour were poor neo liberal hand maidens, National are worse but with better spin doctors. Pun intended.
Undo the corparatising of health then we will be making progress.
The operating model is a minor element in this. As my larger piece, there were already efforts underway to regionalise and standardise. That’s not new.
2500 vacancies exist right now in nursing, mental health is in crisis, GP practices are going to close after the Government's low ball off (and another broken promise).
I could go on but I do think there is some truth in we get the governments we deserve.
Of course there was a a plan and a website and loads of background information. What was missing perhaps was insufficient marketing to get the public on-side and understanding that the reforms were going to make everything work better – upgraded & more secure IT systems, balancing regional demand, cutting layers of duplication and bureaucracy, and better targeted assistance to Maori and Pasifika.
We can't "just let the medicos get on with it" if they are understaffed, underpaid, and there's nobody doing the necessary support work – management, budgets, IT, maintenance, cleaning, etc.
Totally roblogic ! Reti also gets to lay out the bs about 14 layers of management as noone calls him out on it i.e. media doing their job.
Its the way they spray and walk away with no challenges to their spin, reported as is, so the show rolls on trashing our health system.
When I look back on this political landscape, after only having started to pay attention after Luxon and co. were already in power, but doing a lot of research on matters historical and present when I write, I see that Labour were completely overpowered by effective bad faith messaging. And Labour didn't seem to have the resources or ability to fight misinformation effectively, in my view. In that type of scenario, the real losers are not a political party – it's the country.
We see the same in the US and UK. Misinformation kills. And the people who spread it are almost invariably self invested types working for larger, corporate agendas.
Is it pen and paper when IT personnel has gone!?
Its loss of service when IT folk are not there to keep the lights on.
Medicines very digital now with the records and data flow between systems and devices that use telemetry.
Theres no going back to paper in many cases so they're literally playing with lives here.
FYI this is a Newsroom Pro Link…so, subscription. But you can still see the Dr Reti difference
From RNZ…
‘Health Minister Dr Shane Reti was clear in his view Health NZ was overspending, and had a lack of oversight.
He told RNZ the overspending was due to back-office staffing, outsourcing of personnel, poor procurement processes for supplies including inventory on expired stock, as well as inflation and population growth.’
https://www.rnz.co.nz/news/political/522883/totally-bloated-new-health-nz-te-whatu-ora-boss-lester-levy-lays-into-bureaucracy
Morale collapsed in the DHBs when Levy was in charge, the guy was loathed. My wife recalls the Xmas "gift" they all got one year – a pair of mini Xmas mince pies that, upon inspection, had an expired use by date. Morale is critical because our health system is held together by cellotape and good will. Expect the outflow of critical staff to rapidly become a torrent and the complete dislocation of entire key areas of health.
It doesn't bode well.
Judging by the profiles, this is a ruthless person who keeps others down while he reports success up.
Here is some reaction from the medical professionals:
https://www.thepost.co.nz/nz-news/350351801/who-lester-levy-man-replacing-health-nz-board
NACT1 is heading (IMO as they always were) to, if not fully privatising NZ Health, then a partial creep of same.
FFS, all Reti, Luxon and cronies blurts about overspends and budgets are just smoke and mirrors for that end.
They can find billions for tax cuts..but sharpen the "pencil" ( Lester Levy's axe !) for Health?
Who voted for them….shame on you.
Something that always sticks in my mind from the Bolger National government of the 1990s.
The first thing you saw when you entered a public hospital – a large sign reading "cashier, and that meant YOU had to pay twice for public hospital services – once in your taxes and twice at the counter.
National is setting us up for privatisation of "public health".
It will do it in bits so as to not look too obvious. First it will be things like cancer services, outpatients services, then emergency services and before we realise it the whole thing will be in the hands of private enterprise.
Public health should be run as a service, not a business, but National is much more interested in the balance sheet than patient outcome.
Blame is a waste of time.
However, for Rotorua Lakes to be in a position of possibly losing their teaching accreditation, because of a directive from politicians to cover the ED Department in Taupo as well as their own, having specialists drive to Taupo to open the unstaffed ED there is a patchwork waiting for a disaster. A rolling maul of mistakes driven by austerity. Even as they crow 'We have put more money in" they know it does not cover costs.
Willis has not allowed for inflation, pay rounds or the cost of recruiting.
Yes Labour made egregious mistakes when applying austerity, which just goes to show not following a plan causes more strife because cost cutting causes flow on effects.
This COC is just abysmal. They don't plan, just cut costs and expect to get a better result. The question has to be asked "who for if not the patients?" Venture capitalists who will buy up money making parts of the "system" because this crowd is all about the money.
As retailers realise this "Rock Star" version of the economy is killing their businesses, as people lose faith that they can do better, as families leave loved ones to look overseas for a better life, as underlying costs are loaded onto an already suffering base, as they cause untold long lasting environmental damage by removing regulations, there will come a tipping point.
Let us hope it is not too late to reverse the damage. Health is the canary or seahorse dying, telling us we are in deep trouble.
As families see the damage to their own, will they swap political horses, or will they find a scape goat.?
How to spread awareness is the question. I agree that blame is useless, but when stories are invented to place blame on others, in order to pull the metaphorical wool over one's eyes so New Zealand can be sold to the highest bidder at the peoples' expense .. this is when education and awareness would help. Thanks for an astute comment.
Him indoors and I don't remember reading or hearing much about the five Board members who had already voted with their feet. How is Luxon and by default Reti allowed to say they were sacked? Was it cheaper to make Levy Commissioner, and tell porkies. Where oh where are the real reporters publishing the news these days? see below
Most of the media are complicit here, parroting whatever Reti/Luxon say.
"When the deficit was noticed and reported to ministers in March, they made no public statements about it.
In fact, it went unmentioned in April’s Budget Policy Statement, in the Budget itself in May and in scrutiny week hearings in June.
https://newsroom.co.nz/2024/07/23/the-buck-stops-over-there/
Exactly, and research says 2 Board members resigned early and 3 said back in April they would not seek another term after July, so sacked were they? No they were not.
2500 extra staff – $130M over budget. 1250 at $100,000 laid off. Presumably the other 625 split between interface and 625 to the regions.
The sort of 2023 grand budget design on a napkin accounting that made Nicola Willis the C of C Minister of Finance. Clearly Levi is her brother from another mother.
I'll first note that some of the extra 2500 staff included people working in IT.
One of the problems that Health New Zealand has is bringing its information system into the 21st C. And also harmonisation from the hospital/PHO to the region and national management oversight.
https://thedailyblog.co.nz/2024/07/22/guest-blog-ian-powell-health-system-it-0-steps-forward-two-steps-back/
https://newsroom.co.nz/2024/07/11/nz-health-system-could-be-stuck-in-20th-century-after-381m-budget-cut/
The CEO referred to planning for greater connection to consultation with regions (the years of transition)
https://www.health.govt.nz/new-zealand-health-system/health-system-reforms/health-system-reform-roadmap
But the Commissar reveals an organisation change.
https://www.stuff.co.nz/politics/350355126/soul-destroying-health-nz-proposes-cuts-recently-established-jobs
Dr Lester Levy was a huge cheerleader for Labour's reforms, saying in 2021:
"In my view, the health reforms proposed by Minister Little and his colleagues are the type of change that have all the potential to result in unparalleled progress for healthcare in New Zealand. There are three crucial elements that give me confidence that these reforms can make a transformational difference. Firstly and most critically, they firmly address the underlying root problems rather than the symptoms; secondly, they are bold and comprehensive rather than the more customary tinkering; and thirdly, the disposition of the minister and his colleagues is calm, thoughtful, compassionate but unquestionably resolute. "
What a player.
See that Covid-19 Data visualisations at RNZ News are still reported by “DHB/Region”
https://www.rnz.co.nz/news/in-depth/450874/covid-19-data-visualisations-nz-in-numbers
Otherwise there is a disconnect between how reports were made before and after the Centralisation of the Health System. Any stats become unfollowable if the areas of reporting are changed – no doubt other data will be similarly compromised.
Last updated 17 June 2024
Doctor
Jekyll………….. Levy continues with his NACT1 equipped axe.Is that code ? It became necessary to destroy the village to save it ?
Ah…Value ! Now were talking : (
And this..
Everything Ive read and seen about NACT1 leads me to believe
"compassionate and caring" is well…down the list. Somewhere near last : (