Speaker 1: Kilda. I'm Georgina Campbell in for Chelsea Daniels and this
Speaker 1: is the Front Page, a daily podcast presented by the
Speaker 1: New Zealand Herald. Several weeks ago, the government dramatically move
Speaker 1: to take control of House New Zealand by appointing Professor
Speaker 1: Lester Levy as a commissioner. He has the unenviable task
Speaker 1: of finding one point four billion dollars in savings while
Speaker 1: also improving services and meeting the government's national health targets.
Speaker 1: In the weeks that have followed, the dire state of
Speaker 1: our healthcare has become clearer, with patient wait times dragging midwinter,
Speaker 1: back office staff facing voluntary redundancy, and new mums struggling
Speaker 1: to get post birth toast. It begs the question will
Speaker 1: this cost cut inevitably be put ahead of healthcare? Today?
Speaker 1: On the Front Page, I'm joined by New Zealand Herald
Speaker 1: senior health reporter Isaac Davidson to find out what the
Speaker 1: troubled state of tafata Aura means for the future of
Speaker 1: healthcare in New Zealand. Isaac, why did the government appoint
Speaker 1: a commissioner at House New Zealand?
Speaker 2: Yeah?
Speaker 3: So really from day one, government started expressing concerns about
Speaker 3: Health and Z or Tafuta Aura's performance. It had already
Speaker 3: talked about being skeptical about the reforms, and so it
Speaker 3: began to act in December broad on this Crown Observer.
Speaker 3: And this was just because of concern about the amount
Speaker 3: of time people waiting and workforce gaps, and these concerns
Speaker 3: then really intensified around March, and this is when it
Speaker 3: became evident how much Health then Z was overspending by
Speaker 3: so said at the time it was around one hundred
Speaker 3: and thirty million dollars a month that it was overspending.
Speaker 3: And it put in place some of these initial responses
Speaker 3: en Z, did you know, hiring freeze around non frontline workers,
Speaker 3: cracking down on overtime and taking leave, but all those restrictions,
Speaker 3: so it weren't enough. And then at the same time
Speaker 3: you had unrest on the board. Three board members didn't
Speaker 3: seek reappointment, another couple resigned before their term is up.
Speaker 3: All these issues just came to a head in July
Speaker 3: and Shane Retty stepped in, brought in the commissioner, Lester Levy,
Speaker 3: who had already been appointed chair at Health end Z.
Speaker 3: Two remaining board members were effectively sacked and the rationale
Speaker 3: that was given at the time, Retti said it was
Speaker 3: basically financial mismanagement that was going to lead to a
Speaker 3: deficit of about one point four billion. They didn't have
Speaker 3: enough oversight and also these reforms that were coming through
Speaker 3: were being mismanaged too.
Speaker 1: So that's pretty serious intervention, right, like a commissioner. Can
Speaker 1: you just put that into context for me?
Speaker 3: Yeah, it's the most serious thing Retti can do in
Speaker 3: terms of the legislation which governs health end zed. He
Speaker 3: has a few options which escalate. One of them was interim,
Speaker 3: one was the Crown Observer. The most serious is bringing
Speaker 3: in a commissioner, which he's now done.
Speaker 1: And Lester Levy was already the chair previously. What else
Speaker 1: can you tell us about who he is a little
Speaker 1: bit about his background?
Speaker 3: Yeah, so he has a long record in these sorts
Speaker 3: of roles in health and academia and local government. So
Speaker 3: he's a trained doctor, that's his background. It's originally from
Speaker 3: South Africa and he's had sort of over twenty five years.
Speaker 3: He's headed up the Blood Service, the old Mercy Ascott Hospital,
Speaker 3: Auckland Transport.
Speaker 2: He also cheered three of the DHBs.
Speaker 3: Under the old system, in Auckland, including counties Minico where
Speaker 3: he met he first met Marjori Uppo, who's now head
Speaker 3: of Health end Z. Just one thing just worth plucking
Speaker 3: out of his background as biography is that when you
Speaker 3: grow up in South Africa, he lived in Sharpville and
Speaker 3: this is where this sort of infamous massacre was when
Speaker 3: police open fire and black protesters. The reason I mentioned
Speaker 3: that is because he said it was only six at
Speaker 3: the time, but it really shaped the rest of his life,
Speaker 3: both his personal life and professional life. Just to pluck
Speaker 3: out a couple of things, he said, I developed a
Speaker 3: mindset of not necessarily it's accepting the status quo, never
Speaker 3: to fall victim to complacency and different rance. Never had
Speaker 3: a great desire to fit in. And he also said
Speaker 3: they don't need to be popular or part of the establishment.
Speaker 2: Yeah.
Speaker 3: I mentioned that because it gives you a bit of
Speaker 3: a clue about why he's taken on this hard roll
Speaker 3: and my government might bring him in. And also just
Speaker 3: when he's facing so much resistance from the health system,
Speaker 3: that's sort of the background that he's bringing in.
Speaker 1: Yeah. Absolutely, And look you've mentioned Marjie Arper. How is
Speaker 1: Lester Levy getting on in terms of working alongside the
Speaker 1: chief executive and management at health en Z to funt Aura.
Speaker 3: Yeah, yeah, he knows her well, so he was chair
Speaker 3: or while she was chief executive at Counties. I think
Speaker 3: they got off to a pretty bad start. In that
Speaker 3: very first press conference when he was brought in commissioner,
Speaker 3: he was asked directly did he have confidence in his
Speaker 3: chief executive? And his first response was fair question, Professor Levy.
Speaker 4: I know this is a kind of brutal question to
Speaker 4: ask in this context, but then don't you've moved of
Speaker 4: them as a County's actually said three years to get
Speaker 4: speeding with him, two years just to cret years to
Speaker 4: get to spend with in constraints. Do you have confidence
Speaker 4: in her long term? So yeah, to answer that and
Speaker 4: fair questions, so I've just been appointed.
Speaker 2: What I can and will say is that.
Speaker 4: I've been impressed by Margie's willingness to readjust to a
Speaker 4: new direction and the effort that she's making to do that.
Speaker 4: I'm not fixed on outcomes about any of these things,
Speaker 4: open on outcomes, so we see how it goes. Right
Speaker 4: at the moment, Do I have confidence in Marjorie to
Speaker 4: do what we need to do? Yes, I do, because
Speaker 4: she's already doing it.
Speaker 3: It went on to say that it being impressed by
Speaker 3: a willingness to sort of take how things had in
Speaker 3: a new direction. But that's not exactly a ringing endorsement,
Speaker 3: and since then it has got worse in some senses.
Speaker 3: There was this moment last month when health Ing ZIR
Speaker 3: bosses gave a presentation internal presentation which Margie was part of,
Speaker 3: and they outlined how thousands of jobs were being reviewed,
Speaker 3: including specialists and nurses, and this led to Leicester Lee
Speaker 3: by giving a pretty extraordinary public critic of the leadership,
Speaker 3: including Marjorie Arpa. It used words like unacceptable, deeply disappointing.
Speaker 3: It's a direct conflict with commitments he had made around
Speaker 3: not cutting the front line, so that relationship already had
Speaker 3: a few wobbles.
Speaker 1: Yeah, it was pretty public criticism. Is there any indications
Speaker 1: to what their relationships like now or have we seen
Speaker 1: anything else play out in public since then?
Speaker 2: We haven't.
Speaker 3: That has sort of really been the last we've heard
Speaker 3: on it. I guess one thing to add was that
Speaker 3: Upper might have reason to be concerned if you look
Speaker 3: at the way that government has acted in other sort
Speaker 3: of underperforming or what it sees as underperforming areas. If
Speaker 3: you look at Kaiing Aura put out a big review,
Speaker 3: came back with damning results, and then rarely was quite
Speaker 3: ruthless and rolled the entire boards. So she would surely
Speaker 3: have one eye on that sort of thing.
Speaker 1: And you have mentioned some of the financial difficulty. Can
Speaker 1: we just dig into that a little bit more? What
Speaker 1: do we know about the state of House New Zealand's books.
Speaker 3: Yeah, so when the commissioner was brought in there was
Speaker 3: sort of two distinct arguments. Government said this is financial
Speaker 3: mismanagement and the opposition or labour said, well, actually it's
Speaker 3: underfunding how things. He is underfunded. So if we look
Speaker 3: back we can see that how things he had ran
Speaker 3: a deficit in its first year, so this is twenty
Speaker 3: twenty two to twenty three, but these were one off problems,
Speaker 3: mostly costs related to COVID, so nothing too major. It
Speaker 3: was then projected to make savings in its second year.
Speaker 3: This is partly because of it was all streamlining and
Speaker 3: reducing duplication and services and so forth. But this is
Speaker 3: as I mentioned earlier, it became apparent this wasn't going
Speaker 3: to happen. It was by March this year, it was
Speaker 3: clear that it was spending sort of one hundred and
Speaker 3: thirty million too much a month. It's really important to
Speaker 3: look at what's driving this overspend. Its two key factors.
Speaker 3: One is the pay equity settlement for nurses, and the second,
Speaker 3: which they talked about quite a lot publicly, is overspending
Speaker 3: on nurse recruitment. So New Zealand had a massive shortage
Speaker 3: of nurses aggressively recruited under the previous government and this government,
Speaker 3: and that's now overcorrected. There's still vacancies, but that there's
Speaker 3: got a long way to addressing that. I guess the
Speaker 3: reason it's important to drive those factors is that no
Speaker 3: politician would say we've got too much nurses. So it
Speaker 3: doesn't quite fit as easily with that argument of financial
Speaker 3: mismanagement and wasteful spending when you know that's what's driving it.
Speaker 1: Yeah, So what does labor have to say in response
Speaker 1: to those accusations because this government is blaming the previous
Speaker 1: government for what they say is mismanagement.
Speaker 2: Yeah, that's right.
Speaker 3: So it's opposition in particular. So former Health Minister A
Speaker 3: Cheverel says the problem stem from inadequate levels of funding
Speaker 3: provided by the new government, especially in this year's budget.
Speaker 3: She particularly points to health officials saying earlier this year
Speaker 3: they'd need a bigger top up than forecasts. So before
Speaker 3: the election there was an estimate of what it would
Speaker 3: need that has now changed, and that's because of things
Speaker 3: like demographic changes and inflation. They didn't get this in
Speaker 3: the budget. They got the lower estimate. So to quote
Speaker 3: Verril on this to summon it, the government's trying to
Speaker 3: pretend this is something to do with health and zed governance.
Speaker 2: It is to do with their budget, she said. And
Speaker 2: we saw some backing for this and.
Speaker 3: Editorial and New Zealand Medical Journal a few weeks ago
Speaker 3: and where researchers looked and drilled down into this and
Speaker 3: said cost overruns were unlikely to be solely caused by
Speaker 3: port management and really successive governments had underfunded health.
Speaker 1: So plenty of problems are pretty big mountain to climb.
Speaker 1: How does Levy plan to turn all of this around?
Speaker 3: Yeah, so he outlined a few priorities, getting spending under control,
Speaker 3: reducing bureaucracy. We had this slightly notorious comic now that
Speaker 3: Christopher Luxe and the Prime Minister made around there being
Speaker 3: fourteen layers of bureaucracy between the top of tafutor and
Speaker 3: the patient has now been shown to be slightly false,
Speaker 3: but les Leeves certainly said it's a bloated organization. That's
Speaker 3: what he wants to crack down on. Also talking about
Speaker 3: better value for spending, so improving performance. That's really around productivity,
Speaker 3: and he singled out surgical weightlist or weightlists, which blown
Speaker 3: out as really one of his top priorities. He's also
Speaker 3: wanting healthcare to become more localized again, so under Health
Speaker 3: n Z it feels it's become too centralized.
Speaker 2: In Wellington.
Speaker 3: He's talked about a hard reset and he's made some
Speaker 3: moves already in that direction by appointing for regional deputy
Speaker 3: chief executives and rationale for that is what he calls
Speaker 3: bringing decision making closer to communities. So there's a bit
Speaker 3: of devolvement going on there, but the main thing is
Speaker 3: really tackling that overspend and changing the shape of health
Speaker 3: in New Zealand making it a bit smaller, changing its
Speaker 3: structure and reducing non frontline roles to meet this budgets.
Speaker 1: And one of the things that has been put on
Speaker 1: the table is a voluntary redundancy scheme. Can you tell
Speaker 1: us more about that.
Speaker 3: Yeah, So last week care was put out by Tafatura
Speaker 3: for voluntary redundancies to people working in health administration, advisory
Speaker 3: and knowledge roles.
Speaker 2: This is what they would call back office roles. The
Speaker 2: union says.
Speaker 3: The jobs like are people that schedule operations, keeping on
Speaker 3: top of supply chains HR communications. So people can now
Speaker 3: put their names forward. That's the limit of it so far,
Speaker 3: but it may be extended further if they do want
Speaker 3: to cut more jobs.
Speaker 1: The PSA, in response to that redundancy scheme said, this
Speaker 1: looks like and I quote, to be part of the
Speaker 1: government's agenda to strip back public services as a prelude
Speaker 1: to privatization. Is there any truth to that, any response
Speaker 1: from the government to those suggestions.
Speaker 3: It's a big claim and I haven't seen government respond
Speaker 3: to it. I guess at the heart of that is
Speaker 3: the concern that while politicians would call these back office
Speaker 3: roles that by removing them, you desabilize the foundations of
Speaker 3: the health system. That's what the union said, So it's
Speaker 3: cutting the staff which make diagnosis and treatment possible. The
Speaker 3: people to underline that, and also that it's unfocused and
Speaker 3: broad it's cost cutting without considering how it to.
Speaker 2: Affect people's health.
Speaker 3: I think psare probably thinking a little bit as well
Speaker 3: about the UK, where under a conservative government the NHS
Speaker 3: was ground down and underfunded and then services were privatized.
Speaker 3: One more thing to mention is that in this underfunded
Speaker 3: health system there's already been sort of a quiet creep
Speaker 3: of private ownership in some areas. I'm thinking of the
Speaker 3: diversion of elective surgeries into private practice of private doctor
Speaker 3: has been helping out with backlogs, and also the purchase
Speaker 3: of GP clinics by private companies.
Speaker 1: And just on cost cutting. I wrote a story at
Speaker 1: the weekend about Wellington Regional Hospital no longer offering to
Speaker 1: host with spreads to mums who have just given birth.
Speaker 1: They said that they were doing this following advice from
Speaker 1: dietitians that toast is nutritionally suboptimal. Labor said it believes
Speaker 1: this is cost cutting, and a father whose partner had
Speaker 1: given birth that weekend was also told by hospital staff
Speaker 1: that it was cost cutting.
Speaker 5: Lead emails seen by One News shows the moves not
Speaker 5: just about nutrition than king. A Health New Zealand general
Speaker 5: manager wrote to Stuff saying the patient food budget blew
Speaker 5: out by one and a half million dollars last year,
Speaker 5: part of the reason being staff and members of the
Speaker 5: public were eating the food. He said, in the fiscal environment,
Speaker 5: these practices are untenable.
Speaker 6: This is such a small cost saving strategy on the
Speaker 6: scale of the becasts that a hospital has, but a
Speaker 6: massive cost for goodwill.
Speaker 1: So it's an interesting example of what's going on. And
Speaker 1: a piece of toast is such a simple thing. A
Speaker 1: loaf of bread doesn't cost a lot, but it clearly
Speaker 1: meant so much and has meant so much to mums.
Speaker 1: Lots of people posted on social media about a cup
Speaker 1: of tea or a milo and a piece of toast
Speaker 1: after giving birth was just the best toast that they'd
Speaker 1: had in their life. Can you tell us a bit
Speaker 1: more about that or what you make of it, or
Speaker 1: if you have your own experience.
Speaker 3: Yeah, I do bring a little bit of personal experience
Speaker 3: to this. When we had our second child at Auckland Hospital,
Speaker 3: we went across the road to part our birth care
Speaker 3: and it was late at night, about ten or eleven
Speaker 3: at night, and we were supplied a brilliant cheese toasty
Speaker 3: by the care there. And it's hard to overstate how
Speaker 3: good that was. It was sort of this transcendent culinary experience.
Speaker 3: And I'm not even the one that did all the
Speaker 3: work with having our child, so I can see. It's
Speaker 3: just one of those emotional issues of when funding affects
Speaker 3: people on a human level, it just brings the mind
Speaker 3: as well. When Lester Levy gave his first speech as Commissioner,
Speaker 3: and one of the other things he said amongst his
Speaker 3: priorities was so the health system needs to be more compassionate,
Speaker 3: he gave this slightly extraordinary quote that the health system
Speaker 3: needs to be infused with the milk of human kindness.
Speaker 3: It's quite maternal image. I think denying mother's a piece
Speaker 3: of toast after birth is probably not what he had
Speaker 3: in mind, but it's one of those issues. It's sort
Speaker 3: of the funding debate in microcosm rearly in one hand
Speaker 3: saying it's been done for health reasons, you know, mutual reasons,
Speaker 3: the other because there's.
Speaker 2: Not enough money.
Speaker 3: And we'll see more stories like this and more serious
Speaker 3: ones as this sort of funding debate goes on. You know,
Speaker 3: it reminds us as real people behind these decisions and
Speaker 3: whose experience of health system might be suffering. We've seen
Speaker 3: a few really serious examples just in the last week,
Speaker 3: you know, people queuing from six am to see a
Speaker 3: gp in Otara hospital eds without doctors overnight.
Speaker 1: Yeah.
Speaker 3: As I say, see a lot more stories like this
Speaker 3: was the health system and transition or someone' say in crisis.
Speaker 1: The toast situation is certainly not what the House Minister
Speaker 1: Shane Retti had in mind and he strongly urged the
Speaker 1: hospital to reconsider its position and just to say that
Speaker 1: it has. In fact you turned and toast will continue
Speaker 1: to be offered for new muns. I mean, what does
Speaker 1: the current state of House New Zealand mean for the
Speaker 1: future of our housecare? Is it that we're just going
Speaker 1: to see more and more of these stories as you say.
Speaker 3: Yeah, I mean the bigger picture is you've got these big,
Speaker 3: long running problems that are beginning to stack up on
Speaker 3: top of each other. You got growing aging population, people
Speaker 3: with more complex conditions, iniquities and in terms of access
Speaker 3: to health care depending on where you live or your ethnicity.
Speaker 3: And at the same time you've got a shrinking, aging
Speaker 3: workforce means exhausted and burnt out and laid over that
Speaker 3: you've got the shock of COVID nineteen, which is still
Speaker 3: reverberating and affecting things like shortages and waitlists. So it's
Speaker 3: a concern when you look at all that the biggest
Speaker 3: health provider in the country is in poor shape. You know,
Speaker 3: Health New Zealand was broad in after a big review
Speaker 3: and it was meant to be a new way of
Speaker 3: doing things, tackling and equity and providing consistent healthcare around
Speaker 3: the country. It's now just over two years old, it's
Speaker 3: already been drastically altered, and now some of its reforms
Speaker 3: are being reversed. Our health authority scraped, the board's gone.
Speaker 3: So Levy really needs to get Health end Zed working
Speaker 3: quickly if we're going to fulfill some of the promise
Speaker 3: on which it was built and tackle some of these
Speaker 3: really big picture issues. He said in a speach a
Speaker 3: couple of things that's worth pointing out. He said, I'm
Speaker 3: not a religious person, but please pray for me, so
Speaker 3: I don't think he's got any illusions about the task ahead.
Speaker 3: He also said one thing that sort of came as
Speaker 3: a bit of a warning that in terms of the
Speaker 3: changes he's making, they're going to be fast and painful.
Speaker 3: I certainly don't know that some of the issues that
Speaker 3: are changed. I'm not sure about the fast part, but
Speaker 3: I'd certainly agree that there's probably quite a bit more
Speaker 3: pain to come.
Speaker 1: Thanks so much for joining us, Isaac. That's it for
Speaker 1: this episode of the Front Page. You can read more
Speaker 1: about today's stories and extensive news coverage at zidherld dot
Speaker 1: co dot nzed. The Front Page is produced by Ethan
Speaker 1: Sills and sound engineer Patti Fox. I'm Georgina Campbell. Subscribe
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Speaker 1: the headlines.