Mountain Tui: Who will hold Chris Luxon and Shane Reti accountable for the Health NZ deception?

Written By: - Date published: 5:20 pm, July 29th, 2024 - 21 comments
Categories: budget 2024, Christopher Luxon, health, Shane Reti - Tags: , ,

This is based on Mountain Tui‘s earlier substack post.

In the days since the bombshell “firing” of Health NZ’s board and the appointment of a Health Commissioner, a lot has become clearer about PM Luxon and Health Minister Shane Reti’s claims.

How accurate were they, and what do you need to know?

Let’s examine the claims one by one.

CLAIM #1

Reti and Luxon said that Health NZ was unexpectedly blowing through its health budget to the tune of $130mn a month. Reti used the word “miraculously” to indicate it appeared out of nowhere

WHAT WE NOW KNOW (#1)

Luxon and Reti knew about the operational deficit in October 2023. Listen to Luxon in his own words on right wing media. He says he knew about the $130mn “deficit” last year.

Yes that’s right.

Luxon, Reti and Willis already knew about the projected “deficit”, yet appear to have underfunded Health NZ to the tune of $1.4bn in the May 2024 budget, and declared an unexpected, unforeseen funding crisis in July 2024.

CLAIM #2

Reti and Luxon called it a ‘deficit‘. Luxon also said no amount of deficit was acceptable to him.

WHAT WE NOW KNOW (#2)

Is it a deficit if you intentionally underfund Health NZ of what you knew it needed, before you set the budget?

Most of the extra costs were due to Health NZ successfully recruiting nurses to address our nursing shortfall. There were other items like backdated holiday pay and the like which was on the agenda even last year.

Earlier in the year, Reti even said: Health NZ “delivered a financial break-even result in its first year after establishment”

They were alerted to the context through Health select committees earlier in the year, from public reports, Health NZ’s annual report, and presumably from the Health NZ Board – most of whom had already left and resigned by the time the Board was “fired.”

NOTE: This is ALL against the backdrop of the government admitting we still have a shortfall of ~2500 nurses, including 500 in mental health.

CLAIM #3

Shane Reti and Luxon claimed that Health NZ had 14 layers of management, and the distance between the frontline and decision makers contributed to the deficit. When asked what those 14 layers were, Reti looked down and indicated it was so complex, he couldn’t remember it all.

WHAT WE NOW KNOW (#3)

There are not 14 layers of management spread across the whole health system,. Instead, the Government put out a list that included Boards of Directors, patients, doctors, nurses and supervisors who are basically clinicians who have oversight of team members etc. in a grossly misleading representation of Te Whatu Ora / Health NZ’s structure and operations.

Some roles are clearly governance roles including Chairpersons and Directors, executive management roles are the CEO, then you have executive management support in the form of Chiefs of Staffs, and the end people (patients). That 14 is easily whittled down to 8 just on paper. On top of that many roles are often performed by the same person, smaller regions will have less roles than larger more complex organisations, and realising most on that list are clinicians, that 8 looks more suspiciously like 5-6. Reti says his target is six.

In their quest to justify the abolishment of the Health NZ board and appoint the Dr Levy to the role of Health Commissioner, the government made some sloppy miscommunications.

CLAIM #4

Reti claimed the primary reason for the extra costs was the distance between frontline staff and management. He built on the myth of 14 layers of management (see Claim #3) to explain what the root cause of the “blowout” was.

WHAT WE NOW KNOW (#4)

One small wrinkle. Shane Reti, and his boss, PM Luxon, already knew about the reasons and projection for the deficit last year. (See Claim #1)

Further, it wasn’t due to the non-existent 14 layers of management (See Claim #2) It was due to a variety of reasons, and primarily, reducing nurse vacancies from double digit vacancies to single digit % to meet health system needs.

CLAIM #5

Luxon claims his government is spending record amounts on Health NZ.

WHAT WE NOW KNOW (#5)

“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.”

Source: Peter Huskinson

CONCLUSION

There is more, but is that enough?

That pesky health system, hiring nurses, and doctors and carrying out procedures for New Zealanders is a real nuisance it appears, tongue firmly in cheek.

Finally, let’s recap where some of the money is going –

  • $4bn for potholes, including a 24 hour pothole service proudly championed by Mr Simeon Brown
  • ~$3bn for landlords to help them keep their investment properties for longer
  • $12bn in tax cuts – the majority which went to middle income and above classes, and which the govt borrowed $12bn for.
  • $153mn for private charter schools that compete with our public education sector and teachers
  • $60-80mn for David Seymour’s Ministry of Regulation to do as he pleases
  • $1.9bn for a private-public-partnership build for a mega prison and more prisoners etc.
  • $5mn for a pilot military style boot camp, costing $525,000 per youth, that the government has been told doesn’t effectively work, and is at risk of brutalising youths further

21 comments on “Mountain Tui: Who will hold Chris Luxon and Shane Reti accountable for the Health NZ deception? ”

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  1. PsyclingLeft.Always 1
    29 July 2024 at 5:41 pm

    Look, apparently just dont worry …as Willis says "The government has got your back"

    Watch: Nicola Willis joins PM at weekly post-Cabinet briefing

    https://www.rnz.co.nz/news/political/523487/watch-nicola-willis-joins-pm-at-weekly-post-cabinet-briefing

    !? IMO I would not want NACT1 anywhere near my back ! Anyway seems other parts of the media, are also questioning them.

    A good thing ! Again good on you Mountain Tui. You put it all out here for us. Thankyou.

  2. dv 2
    29 July 2024 at 6:04 pm

    The graph of health spend per person by year is telling.

  3. Nic the NZer 3
    29 July 2024 at 6:11 pm

    Regarding claim #3 it should also be highlighted that the Patients have no direct reports. There are only 13 layers of management presented in the PM's own documentation.

    • Mountain Tui 3.1
      29 July 2024 at 6:35 pm

      No that’s not it either.

      The Board of Directors is governance not management.
      CEO is executive management, very different.
      Chief of Staffs are Chief of Staffs – nothing to do with operational management, etc.

      This is a good explanation I found from someone who works in Health:

      “I’ll break it down based on the list in the article apparently provided by Reti.

      Roles 11-13 are generally clinical roles that, while supervisory in function, are also patient-facing. They aren’t considered management roles, they’re frontline. Obviously the patient is not a manager so 14 should be removed. That leaves 10 layers.

      The Chair and Board are governance roles, not management, so number 1 doesn’t count. The Chief of Staff at number 3 is actually on the same tier as the National Directors at number 4. That’s down to 8 layers.

      Roles 9 and 10 won’t exist for every service or every region and sometimes they’re interchangeable with the Service Manager in role 8 or frontline team leader in role 11.

      These manager and assistant manager roles are often on the same tier and are typically only required for large, urban, tertiary hospital services with high complexity and high patient turnover.

      We don’t have as many of those services in NZ as people might think.

      So removing them, we’re down to 6 layers which is the number of layers Reti and Luxon say is desirable in the article.

      In smaller hospitals roles 8-11 might be the same person, a clinician who is a team leader and the service manager.

      So that would be 5 layers, below the threshold Reti wants.

      This is just another demonstration of the government’s willingness to bend the truth to suit their own purposes. While the party line continues to be that frontline staff are not impacted by savings targets or hiring freezes, their inclusion of three tiers of frontline service AND THE PATIENT in their management structure speaks volumes. “

      • Nic the NZer 3.1.1
        29 July 2024 at 6:57 pm

        "No that’s not it either."

        No, I wasn't in fact saying this was the only obvious issue with that list. Just when your boss comes to you and says, make make me a list documenting 14 layers of management at Te Whatu Ora because I just described that to the media, that list should have either 14 management positions, or 15 layers on it.

      • Mike the Lefty 3.1.2
        29 July 2024 at 6:59 pm

        Very good explanation Mountain Tui, thank you.

        All NACT supporters should be forced to read this.

  4. Vivie 4
    29 July 2024 at 7:10 pm

    The article in the following link provides details of the hospital crisis in Northland.

    https://www.rnz.co.nz/news/top/523419/far-north-doctor-shortage-now-acute-clinical-manager-warns

    "Desperately worried doctors in the Far North fear people are dying as a direct result of critical workforce shortages in hospitals.

    In an email to staff leaked to RNZ, a senior clinical manager warns of several high risk areas, including Dargaville Hospital where on-site doctors have been replaced by a telehealth service overnight.

    The chronic doctor shortage in the region had now become "acute", which was not helped by lack of funding to recruit new staff and the recent decision to cut pay for locums to fill the gaps.

    With one doctor retiring, Dargaville Hospital was no longer able to provide safe 24/7 care and was "defaulting" to cover by telehealth and nurses overnight, with critically ill patients transferred to Whangārei by St John's Amublance (sic)…..

    • Dargaville, Kaitaia and Kawakawa hospitals are short 10 senior doctors (more than one in three positions vacant) while resident doctor cover is described as "ad hoc" due to lack of coordinated recruitment and funding.
    • Telehealth doctors are hampered by the "heavy reliance on paper-based medication charting" and the lack of electronic medical protocols in Northland "has resulted in medical error": HIGH RISK…..

    Northland emergency doctor Gary Payinda said staff frequently received messages asking them to cover shifts at rural hospitals.

    But even at the region's main hospital in Whangārei they were struggling to fill rosters.

    Replacing colleagues off sick now required now sign-off from multiple managers.

    "On my last shift there was 133 percent occupancy, on the shift before that 200 percent emergency department occupancy. That means we have twice as many patients seeking emergency care as we have doctors and nurses to see them," he told RNZ on Friday morning.

    Payinda said there was no doubt that people will be dying due to long waits in overcrowded, understaffed emergency departments…..

    The Ambulance Association's head, Mark Quin, said the collapse of primary care in Northland was stretching crews beyond capacity…..

    It was "insulting" to frontline health workers to hear the new Health Commissioner Lester Levy describe the health system as "bloated" and for politicians to deny there was any underfunding, Dr Payinda said.

    "Either they are woefully misinformed and living in a fantasy land – or they are intentionally mangling the truth for political purposes. And I don't know which it is, but either are equally unacceptable.

    "It's real patients whose lives are on the line here, so it's time to start being honest."…..

    Reti said Dargaville's hospital remains viable but may have to rely on what he called alternative service mechanisms until doctor positions can be filled….".

    The Government's cynical attempts to minimise the dire situation are countered by the very informative interviews with Northland doctors on today's RNZ Morning Report. https://www.rnz.co.nz/national/programmes/morningreport

    It would be interesting if media challenged Nicola Willis to justify $12 billion borrowed for tax cuts and $3 billion for landlords, when hospitals are unable to function properly.

    • Chris 4.1
      30 July 2024 at 10:51 am

      Her and Luxon's response would be "we don't agree with that conclusion" and "we have one of the most comprehensive health systems in the world" and most people will accept that.

      • Vivie 4.1.1
        30 July 2024 at 1:54 pm

        Chris: If they are repeatedly challenged by other media in addition to RNZ, with doctors' and nurses' facts and evidence of lack of sufficient staffing for patients' safety, I doubt Luxon, Willis or Reti will be able to dismiss this easily.

        I'm sure you are aware, as many people are, that this is a problem in public hospitals throughout NZ. https://www.nzherald.co.nz/nz/politics/minister-admits-health-system-in-crisis-amid-rural-hospital-staff-shortages.

        • Chris 4.1.1.1
          30 July 2024 at 3:55 pm

          Yes, I've personal experience of beds lined up in an emergency department corridor.

          But my point was precisely about how brazen the likes of Willis and Luxon and Seymour are when they dismiss anything that's at odds with their position by simply saying "I don't agree with that analysis" even when the evidence clearly points the other way. They simply say they don't agree and avoid all scrutiny.

          So I suppose we're saying the same thing which then begs the question of how to deal with this. That's the $64 million question…

  5. PsyclingLeft.Always 5
    29 July 2024 at 8:04 pm

    Reti, Luxon and cronies….. WTF. IMO… What The FUD ?

    https://en.wikipedia.org/wiki/Fear,_uncertainty,_and_doubt

    Hard Questions need asked of them. Again and again.

  6. newsense 6
    29 July 2024 at 11:19 pm

    From Bernard Hickey at the Kaka:

    Health NZ has been very clear in recent months that the increase in costs above its budgeted levels of around $130 million a month was actually because of Holidays Act leave entitlements, new collective agreements with staff, pay equity increases and extra nursing costs because of extra hours being worked in jam-packed hospitals.

    First do no harm, Dr Shane and thou shall not tell lies, Mr Luxon.

    I can’t get the photo off stuff because of this new log in business, but the photo of Luxon leering like he’s buttering up a donor with a guy with a tragic story in the stuff profile is disconcerting. It’s a photo op. There’s no sincerity in the face at all.

  7. Joe 7
    30 July 2024 at 12:28 pm

    The real story should be 'why did the government only fund the HNZ to be 88% staffed. It beggers belief that they had a policy to fix the chronic under staffing and to pay health professionals what they are worth but did not budget for it.

    And now to blame their incompetence on a bloated health system, shows the contempt they have for their fellow kiwis. Absolute gall!

  8. gsays 8
    30 July 2024 at 12:35 pm

    Two further things really shred the undies.

    Most nurses who are owed back pay, to the tune of 100s of millions of dollars, for up to 8 years, have still not been paid.

    ""We completed the first remediation payments to current employees on our seven payrolls in the Auckland region in 2023, and we expect to complete the remaining 17 payrolls in 2024,” Slater said"

    https://www.thepress.co.nz/nz-news/350208007/health-workers-fed-delay-owed-holiday-pay

    The other is what a useless opposition we have. Or, what useless 'communication consultants' they employ.

    I suppose Labour are hamstrung in that they aren't covered in glory, what with deciding to restructure a health system during a pandemic and all.

  9. PsyclingLeft.Always 9
    30 July 2024 at 2:58 pm

    Health Minister Shane Reti faces growing pressure over Health NZ finances

    And… whoop whoop…Luxon abandons Dr Reti. Is there a Dr in their house ?

    Luxon also said it was Reti that supplied him with the information claiming the 14 layers of management.

    On Tuesday he was clear Reti held responsibility for the portfolio.

    https://www.rnz.co.nz/news/political/523594/health-minister-shane-reti-faces-growing-pressure-over-health-nz-finances

    Well..seems the heat being applied.. is getting to the CoC crew

    Keep them under the questioning.

  10. Adrian 10
    30 July 2024 at 3:01 pm

    They are blatant lying bastards, in the last few weeks two highly trained nurses that I know of, with full NZ registration at a cost of 30k each have gone back to India because they could not get a job anywhere because no hospitals are hiring. Suspiciously, rest homes etc are not doing so either, is this because of a sinking budget lid for rest homes? Also nurses are being paid wages and mileage to travel 150 kms between two SI towns for day shifts on top of normal wages because of this hiring freeze. It’s chaotic, incompetent and dangerous deceitful bullshit from the most inept bunch of fuckwits to ever hijack our governance.

  11. Patricia Bremner 11
    30 July 2024 at 3:58 pm

    Yes Adrian, the many pigeons are coming home to roost and splat all over them.

    So now to cover their derriere, they have formed a "Committee"

    Hospitals without Doctors, Nurses without jobs, Clinicians having to travel from one center to another because of staff shortages … and so it goes on,crying showing their lies.

  12. Psych Nurse 12
    30 July 2024 at 4:02 pm

    I work as a Duty Nurse Manager of a Mental Heath Hospital after hours, that is from 1515 to 2330 or 2300 to 0730. The management structure. Below me Registered nurses, above me an oncall Service manager contactable by phone. That is hardly 14 layers of management. That structure is the same country wide.

  13. Mike the Lefty 13
    30 July 2024 at 8:44 pm

    The bulk of National and ACT supporters would probably not use the public health system anyway, they can afford health insurance to go private so why should they care if public health goes down the gurgler?

    They have more important things to think about – like when all the potholes in the roads will be filled and speed limits raised and when will the next new Ford Ranger model come out.

  14. Jack 14
    31 July 2024 at 6:00 am

    Thanks for going to the trouble of digging into this. It all seems like a manufactured crisis. What is the hidden agenda here?