Mountain Tui: Can we talk about New Zealand’s health system?

Written By: - Date published: 11:25 am, July 23rd, 2024 - 96 comments
Categories: budget 2024, Christopher Luxon, health, Shane Reti - Tags: , ,

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? ”

  • Comments are now closed

  1. Barfly 1
    23 July 2024 at 11:40 am

    but Reti appears to have stuck his hand head in the sand

  2. Barfly 2
    23 July 2024 at 11:46 am

    "Yes, the budget that they screwed the porch pooch on"

  3. Adrian 3
    23 July 2024 at 12:48 pm

    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.

  4. Barfly 4
    23 July 2024 at 2:15 pm

    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!

    • That_guy 4.1
      23 July 2024 at 2:41 pm

      The Greens independently cost all their budgets because they know they’ll get crucified for the slightest mistake.

    • Graeme 4.2
      23 July 2024 at 3:20 pm

      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

    • Anker 4.3
      23 July 2024 at 6:46 pm

      How come the new Health NZ needed 2500 extra bureacrats?

      • Craig H 4.3.1
        23 July 2024 at 8:09 pm

        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.

        • Anker 4.3.1.1
          23 July 2024 at 8:42 pm

          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.

          • Mountain Tui 4.3.1.1.1
            23 July 2024 at 9:02 pm

            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.

            • Obtrectator 4.3.1.1.1.1
              23 July 2024 at 11:11 pm

              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.

  5. Kay 5
    23 July 2024 at 3:39 pm

    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.

    • Anker 5.1
      23 July 2024 at 6:47 pm

      We will have to wait and see

    • Anker 5.2
      23 July 2024 at 8:44 pm

      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

      • Kay 5.2.1
        23 July 2024 at 8:54 pm

        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.

    • Mountain Tui 5.3
      23 July 2024 at 9:03 pm

      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.

      • Ghostwhowalksnz 5.3.1
        24 July 2024 at 2:05 pm

        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

    • tWig 5.4
      24 July 2024 at 11:20 am

      Big Hairy News talk with Ayesha Verrall, over Coalition's Health approach, first 15 min.

  6. thinker 6
    23 July 2024 at 5:12 pm

    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?

  7. Anker 7
    23 July 2024 at 6:44 pm

    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.

    • Mountain Tui 7.1
      23 July 2024 at 9:05 pm

      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.

  8. PsyclingLeft.Always 8
    23 July 2024 at 7:02 pm

    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…..

    https://en.wikipedia.org/wiki/Lester_Levy

    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. : )

    • Mountain Tui 8.1
      23 July 2024 at 9:06 pm

      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.

  9. Ad 9
    23 July 2024 at 7:08 pm

    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.

    • weka 9.1
      23 July 2024 at 7:22 pm

      all of this.

      How much did the Dndn Labour vote drop?

    • Anker 9.2
      23 July 2024 at 8:47 pm

      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

      • Mountain Tui 9.2.1
        23 July 2024 at 9:35 pm

        Levy is a South African qualified doctor who then migrated to New Zealand and was recognised in December 1979 as a general registrant (non-specialist) by the Medical Council. He subsequently switched to management although, years later, he was vocationally (specialist) recognised in medical administration.
        In the 1990s he was a strong public supporter of the failed attempt to run the health system as a business. This included a short period as chief executive of South Auckland Health responsible for Middlemore Hospital where he was a positive liberating influence.

        From the late 1990s he was largely out of the public health system, until he was appointed by National health minister Tony Ryall as chair of Waitemata DHB in 2009. This was followed by his appointments as chair of Auckland DHB (2010) and Counties Manukau DHB (2016). He resigned all three positions in December 2017 following the change of government, but in June 2019 came back into favour when Labour health minister David Clark was persuaded (in part by Ernst & Young consultants) to appoint him as a Crown monitor to Canterbury DHB, reporting directly to the minister.

        Levy’s style had radically changed upon his return to the fold in 2009, with what was viewed by many as an increasingly top-down, controlling and destructive approach. In each of the positions, he came in with an embellished assertion that he had inherited a financial mess and was the right person to fix it.

        In each of the four DHBs, the chief executives resigned; Canterbury’s David Meates survived longer but almost all the senior leadership team also resigned. Morale also plummeted (less so in Waitemata but dramatically in Counties Manukau and Canterbury). Ironically, following his appointment as their chairs, the three Auckland DHBs went from financial surpluses to deficits.

        Newsroom

    • Mountain Tui 9.3
      23 July 2024 at 9:18 pm

      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.

      • Ad 9.3.1
        24 July 2024 at 8:32 am

        If the real crisis is "the system" as you suggest, Labour designed that system from the ground up.

        • Mountain Tui 9.3.1.1
          24 July 2024 at 9:30 am

          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:

          “The simple answer is underfunding. Lester Levy can say there is more money going in now than ever before but the trouble is they are still not putting enough in,” he said.

          “I don’t see how it’s going to work,” Gousmett said.

          Christchurch surgeon Frank Frizelle said Levy was a very bright business person.

          “He’s a very able person. He seems to be a person who’s involved in big decisions but usually behind the scenes,” he said.

          “[Levy’s] experience shows he can deliver and I think he’s a fix-it person brought in and he’s capable. He’s saying all the right words. Can he do it? I don’t know…The buck stops with him.”

          However, Christchurch surgeon Phil Bagshaw, founder of the Canterbury Charity Hospital, said Levy’s promises were “neo-liberal fantasy”.

          “The health system has been seriously underfunded for decades. Anybody who thinks they can come in an make sweeping changes to the system should talk to the doctors and nurses who are working themselves to exhaustion to keep a failing system going,” he said.

          Executive Director of the Association of Salaried Medical Specialists Sarah Dalton said she had seen no data to back up Levy’s assertions about staffing levels and was sceptical about whether he could make changes to patient outcomes without spending more money.

          “Our members, senior doctors and dentists, are working under significant staffing shortages…If he can turn it around on the same budget that’s great but New Zealand’s health care spend doesn’t stack up compared to other developed countries,” she said.

          “Talk is cheap,” she said.

          https://www.thepost.co.nz/nz-news/350351801/who-lester-levy-man-replacing-health-nz-board

          • Will 9.3.1.1.1
            24 July 2024 at 3:09 pm

            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.

            • Mountain Tui 9.3.1.1.1.1
              25 July 2024 at 2:31 pm

              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.

              • Will …
                25 July 2024 at 3:37 pm

                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)

                • Will …
                  25 July 2024 at 4:00 pm

                  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.

                  • Incognito …
                    25 July 2024 at 4:39 pm

                    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.

                  • Mountain Tui …
                    28 July 2024 at 5:26 pm

                    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

                • SPC …
                  25 July 2024 at 4:49 pm

                  "Following the election, new estimates of cost inflation and of population growth were made and those were not funded by this government – that's why there's a deficit."

                  In the link, inflation since then.

                  • Will …
                    25 July 2024 at 5:55 pm

                    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.

                    • Mountain Tui …
                      25 July 2024 at 6:14 pm

                      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.

              • Will …
                25 July 2024 at 6:23 pm

                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

                • Mountain Tui …
                  25 July 2024 at 7:16 pm

                  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.

                  • Will …
                    25 July 2024 at 7:25 pm

                    His 2021 ‘cheerleading’ came with a very big proviso. One he nailed.

                    By the way, where is your link to the $2bn claim?

                    • Mountain Tui …
                      25 July 2024 at 8:30 pm

                      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.

                  • Will …
                    25 July 2024 at 8:41 pm

                    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]

                    • Mountain Tui …
                      25 July 2024 at 10:02 pm

                      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.

                    • weka …
                      25 July 2024 at 11:13 pm

                      mod note.

                    • Will …
                      26 July 2024 at 10:08 am

                      I'm sorry Weka, I'll dial it back.

                    • weka []
                      26 July 2024 at 10:16 am

                      thanks. Can you please look at the additional mod note?

                    • weka …
                      26 July 2024 at 10:15 am

                      additional mode note. Please reply to my comment here acknowledging you have seen and understood.

                    • Will …
                      26 July 2024 at 10:32 am

                      Hi Weka. I'll only post here as Will. Thanks.

            • Mountain Tui 9.3.1.1.1.2
              25 July 2024 at 4:56 pm

              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

              • Will …
                25 July 2024 at 6:03 pm

                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.

                • Mountain Tui …
                  25 July 2024 at 6:10 pm

                  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.

                  • Will …
                    25 July 2024 at 6:22 pm

                    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.

                    • Mountain Tui …
                      25 July 2024 at 7:14 pm

                      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.

                  • Will …
                    25 July 2024 at 7:23 pm

                    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'.

        • Incognito 9.3.1.2
          24 July 2024 at 4:01 pm

          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.

    • SPC 9.4
      24 July 2024 at 3:31 pm

      Labour spent an inordinate amount of time developing a Maori-only health provision arm that just pissed everyone off.

      Hardly, not even all white people.

      Lock down major IT reform in 2 years …

    • Will 9.5
      24 July 2024 at 6:42 pm

      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)

      • Incognito 9.5.1
        24 July 2024 at 8:22 pm

        Shocking!

        What’s your point?

        And something happened after the HDSR was completed, didn’t it?

      • Mountain Tui 9.5.2
        25 July 2024 at 4:56 pm

        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

  10. feijoa 10
    23 July 2024 at 7:34 pm

    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.

    • weka 10.1
      23 July 2024 at 7:43 pm

      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.

      • gsays 10.1.1
        25 July 2024 at 9:07 am

        "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.

    • Mountain Tui 10.2
      23 July 2024 at 9:20 pm

      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.

    • roblogic 10.3
      23 July 2024 at 11:02 pm

      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.

      • tc 10.3.1
        24 July 2024 at 7:13 am

        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.

      • Mountain Tui 10.3.2
        24 July 2024 at 9:36 am

        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.

  11. benby 11
    23 July 2024 at 8:33 pm

    Is it pen and paper when IT personnel has gone!?

    • tc 11.1
      24 July 2024 at 8:11 am

      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.

  12. PsyclingLeft.Always 12
    24 July 2024 at 9:07 am

    FYI this is a Newsroom Pro Link…so, subscription. But you can still see the Dr Reti difference

    Unexpected success hiring nurses drives Health NZ deficit

    Health NZ’s chief executive says nurse recruitment will need to be reined in to stay within future Budgets, suggesting at least a degree of underfunding.

    Analysis: The health system's massive recruitment drive for new nurses was far more successful than expected, with the hiring of thousands of new nurses in the past year driving much of the deficit at Health NZ, chief executive Margie Apa says.

    https://newsroom.co.nz/2024/07/24/unexpected-success-in-hiring-nurses-drives-health-nz-deficit/

    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

  13. Sanctuary 13
    24 July 2024 at 9:19 am

    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.

    • Mountain Tui 13.1
      24 July 2024 at 9:33 am

      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:

      “The simple answer is underfunding. Lester Levy can say there is more money going in now than ever before but the trouble is they are still not putting enough in,” he said.

      “I don’t see how it’s going to work,” Gousmett said.

      Christchurch surgeon Frank Frizelle said Levy was a very bright business person.

      “He’s a very able person. He seems to be a person who’s involved in big decisions but usually behind the scenes,” he said.

      “[Levy’s] experience shows he can deliver and I think he’s a fix-it person brought in and he’s capable. He’s saying all the right words. Can he do it? I don’t know…The buck stops with him.”

      However, Christchurch surgeon Phil Bagshaw, founder of the Canterbury Charity Hospital, said Levy’s promises were “neo-liberal fantasy”.

      “The health system has been seriously underfunded for decades. Anybody who thinks they can come in an make sweeping changes to the system should talk to the doctors and nurses who are working themselves to exhaustion to keep a failing system going,” he said.

      Executive Director of the Association of Salaried Medical Specialists Sarah Dalton said she had seen no data to back up Levy’s assertions about staffing levels and was sceptical about whether he could make changes to patient outcomes without spending more money.

      “Our members, senior doctors and dentists, are working under significant staffing shortages…If he can turn it around on the same budget that’s great but New Zealand’s health care spend doesn’t stack up compared to other developed countries,” she said.

      “Talk is cheap,” she said.

      https://www.thepost.co.nz/nz-news/350351801/who-lester-levy-man-replacing-health-nz-board

  14. PsyclingLeft.Always 14
    24 July 2024 at 9:52 am

    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.

    • Mike the Lefty 14.1
      24 July 2024 at 10:01 am

      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.

  15. Patricia Bremner 15
    24 July 2024 at 11:51 am

    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.?

    • Mountain Tui 15.1
      24 July 2024 at 12:15 pm

      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.

      • Patricia Bremner 15.1.1
        24 July 2024 at 4:27 pm

        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

  16. Ghostwhowalksnz 16
    24 July 2024 at 2:25 pm

    "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/

    • Patricia Bremner 16.1
      24 July 2024 at 4:37 pm

      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.

  17. SPC 17
    24 July 2024 at 3:25 pm

    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/

  18. SPC 18
    25 July 2024 at 1:20 pm

    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.

    The organisation would also be split into four regions, with a deputy chief executive brought in for each region.

    https://www.stuff.co.nz/politics/350355126/soul-destroying-health-nz-proposes-cuts-recently-established-jobs

  19. Mountain Tui 19
    25 July 2024 at 4:57 pm

    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.

  20. Maurice 20
    26 July 2024 at 12:47 am

    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

  21. PsyclingLeft.Always 21
    26 July 2024 at 8:22 am

    Doctor Jekyll ………….. Levy continues with his NACT1 equipped axe.

    More Health NZ job cuts to come, commissioner Lester Levy says

    "We have to reduce the size of the organisation in order to allow the organisation to be financially sustainable over time."

    Is that code ? It became necessary to destroy the village to save it ?

    "So we need to do more with the resources we've got rather than just constantly asking for more resources cause we need to provide more value."

    Ah…Value ! Now were talking : (

    And this..

    Levy said the goals were to cut waiting times, provide more with existing resources and ensure all contact made with Te Whatu Ora was "compassionate and caring".

    https://www.rnz.co.nz/news/national/523162/more-health-nz-job-cuts-to-come-commissioner-lester-levy-says

    Everything Ive read and seen about NACT1 leads me to believe

    "compassionate and caring" is well…down the list. Somewhere near last : (

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