At the time I thought this was a bit off and, at best, of limited alliterative appeal.
But if “Angry Andy” was a bit off then, it is certainly applicable today as Little, now Health Minister, continues to deny the obvious: that there is a crisis in the health system.
In his incomprehensible denial, Little failed to grasp a fundamental truism.
Of necessity, health systems are both highly labour-intensive and integrated; consequently when there is a workforce crisis involving extensive severe shortages of the magnitude we are now witnessing, then the whole system is in crisis.
The biggest factor behind this crisis is neglect of worsening workforce shortages by successive governments, made more challenging by the pandemic.
The Health Minister points to winter flu. But there are two knowns about winter flu. First, winter flu happens every winter. Second, each winter flu is usually more severe than the previous one.
The cumulative pressure and expressions of alarm for both patient and staff safety from those at the frontline and their representative bodies, on the impact of the workforce crisis, have taken their toll on the health minister. He is now lashing out, making a possum caught in the headlights look cool, calm and collected.
In a low blow, in May, Little derogatorily referred to the “nominal leaders” of primary care for allegedly failing to see what a different and better health system looks like. It was clear from the context of his attack that he was referring to representatives of general practices.
This was followed by an insulting criticism of rural general practices. These indispensable practices are vulnerable because their small size and isolation compounds the GP shortage.
Instead of acknowledging their concerns, Little chose to blame practice ownership.
There is a legitimate question about the long-term viability of privately owned general practices in a universal public health system, but they are not the cause of the crisis in providing accessible care to rural communities.
In fact, they are holding rural health together in the midst of this politically created crisis. They should be applauded, not targeted by a cheap shot.
Then he unnecessarily put the boot into New Zealand’s drug purchasing agency Pharmac calling it an “independent republic”. Being an independent republic is the last thing Pharmac is, if for no other reason than it isn’t possible.
Pharmac is controlled by government funding which has been well short of what approved medicines are needed and what Pharmac would want to purchase (acknowledging a big percentage increase in the last Budget, but from a low base).
There have been issues with Pharmac such as transparency over decision-making, But it has been successful in negotiating with a sea of profit-maximising sharks (aka international pharmaceutical companies).
In all of this, it has been severely constrained by government funding. Nothing independent about this.
Moving on, Minister Little then got personal with Waikato emergency medicine specialist Dr John Bonning (also President of the Australasian College of Emergency Medicine and deputy chair of the Council of Medical Colleges) attacking him for embellishing the workforce crisis in hospitals. In fact, it is a characteristic of Dr Bonning to understate rather than overstate.
And he is getting stuck into the NZ Nurses Organisation, accusing the union of reneging on a deal on pay equity. Simply not true.
The “deal” was agreed to by two negotiating teams, but still required ratification. Following membership feedback, NZNO identified two obstacles to ratification which required resolution.
That is not reneging; it is the part of the process called ratification. As a former union leader, Little knows this well.
Little’s poor performance has made him a ministerial liability. A big factor behind this is his failure to recognise the importance of relationships in public health systems.
This has led him to undermine workforce trust and confidence in the Government’s leadership of the health system.
Further, he has achieved this in little over 18 months. I don’t recall any health minister reaching this milestone.
He should take a lesson from James Carville, a strategist in Bill Clinton's successful 1992 presidential campaign. He coined the term, “it’s the economy, stupid”.
For health systems, “it’s relationships, stupid”. Little may be incapable of grasping this, but the Prime Minister should be.
Ian Powell is the editor of the health systems blog Otaihanga Second Opinion HERE, a health commentator, and a former Executive Director of the Association of Salaried Medical Specialists. This article was first published HERE.
The biggest factor behind this crisis is neglect of worsening workforce shortages by successive governments, made more challenging by the pandemic.
The Health Minister points to winter flu. But there are two knowns about winter flu. First, winter flu happens every winter. Second, each winter flu is usually more severe than the previous one.
The cumulative pressure and expressions of alarm for both patient and staff safety from those at the frontline and their representative bodies, on the impact of the workforce crisis, have taken their toll on the health minister. He is now lashing out, making a possum caught in the headlights look cool, calm and collected.
In a low blow, in May, Little derogatorily referred to the “nominal leaders” of primary care for allegedly failing to see what a different and better health system looks like. It was clear from the context of his attack that he was referring to representatives of general practices.
This was followed by an insulting criticism of rural general practices. These indispensable practices are vulnerable because their small size and isolation compounds the GP shortage.
Instead of acknowledging their concerns, Little chose to blame practice ownership.
There is a legitimate question about the long-term viability of privately owned general practices in a universal public health system, but they are not the cause of the crisis in providing accessible care to rural communities.
In fact, they are holding rural health together in the midst of this politically created crisis. They should be applauded, not targeted by a cheap shot.
Then he unnecessarily put the boot into New Zealand’s drug purchasing agency Pharmac calling it an “independent republic”. Being an independent republic is the last thing Pharmac is, if for no other reason than it isn’t possible.
Pharmac is controlled by government funding which has been well short of what approved medicines are needed and what Pharmac would want to purchase (acknowledging a big percentage increase in the last Budget, but from a low base).
There have been issues with Pharmac such as transparency over decision-making, But it has been successful in negotiating with a sea of profit-maximising sharks (aka international pharmaceutical companies).
In all of this, it has been severely constrained by government funding. Nothing independent about this.
Moving on, Minister Little then got personal with Waikato emergency medicine specialist Dr John Bonning (also President of the Australasian College of Emergency Medicine and deputy chair of the Council of Medical Colleges) attacking him for embellishing the workforce crisis in hospitals. In fact, it is a characteristic of Dr Bonning to understate rather than overstate.
And he is getting stuck into the NZ Nurses Organisation, accusing the union of reneging on a deal on pay equity. Simply not true.
The “deal” was agreed to by two negotiating teams, but still required ratification. Following membership feedback, NZNO identified two obstacles to ratification which required resolution.
That is not reneging; it is the part of the process called ratification. As a former union leader, Little knows this well.
Little’s poor performance has made him a ministerial liability. A big factor behind this is his failure to recognise the importance of relationships in public health systems.
This has led him to undermine workforce trust and confidence in the Government’s leadership of the health system.
Further, he has achieved this in little over 18 months. I don’t recall any health minister reaching this milestone.
He should take a lesson from James Carville, a strategist in Bill Clinton's successful 1992 presidential campaign. He coined the term, “it’s the economy, stupid”.
For health systems, “it’s relationships, stupid”. Little may be incapable of grasping this, but the Prime Minister should be.
Ian Powell is the editor of the health systems blog Otaihanga Second Opinion HERE, a health commentator, and a former Executive Director of the Association of Salaried Medical Specialists. This article was first published HERE.
4 comments:
The nurse union have a petition to get do-little out.
There is a first.
I have awaited the accelerated destruction of the New Zealand health system with dread.
On the big day – July 1, all felt much the same but I’ve now learnt this gigantic shifting of the ground beneath our feet will happen in “stages” – each of which will apparently make things much better (really???) but none of which is transparent.
And what do we know of these stages? – beyond better care to those tinged with certain genetics – not much it seems.
I was recently told by a young person who’s parent is high up in health management that that parent had been told by one of the women in charge of the “change-over” that she had “no idea” what she was supposed to be doing!
The one thing we all know however is that, in a stressed to breaking system, any increase in resources for one grouping WILL mean a corresponding decrease in resources for the rest.
Secondly, I believe your comments Ian, about the government’s antipathy towards general practice, are the canary in the coalmine for worse, much, much worse destruction to come.
I found it in the government “future of health” website under “five system shifts’.
It promised:
“Third, high quality emergency or specialist care will be available when people need it. Networks of doctors and other medical professionals will work together with community services to educate and keep people well, so fewer people need healthcare in the first place.”
This idea that we can educate our population to “health”, such that healthcare will be in significantly less demand is a feature promise of naïve health “reformers” everywhere, and always has been. It never works.
But, more ominously, this sounds to me like the planned destruction of general practice – to hide the putting of the general practitioner doctor crisis into the too hard, too costly, basket. Look closely at the above description. Isn’t this what we’ve until now CALLED general practice. Yet the term is now nowhere to be seen!
I shudder to think that it could be so but reading between the government’s own lines I see a dystopic future where general practices are replaced by community “wellness” hubs and access to the GP will be “gatekept” – most usually by a (?barefoot) nurse or health worker.
Private medical records will be accessed by the lowest common denominator and health advice will be dispensed likewise. If one fails to take advantage of, for instance, a referral to the local tohunga, it will be a black mark (hmm, a white mark?) and proof of lack of respect.
You! Go to the back of the queue!
Access to the doctor will no longer be “primary” care but “secondary” - gatekept too, much as the hospitals are gatekept now.
Such a system immediately allows the nurse gatekeeper to significantly improve access to doctors by Maori by restricting doctor access by everyone else.
And don’t bother complaining – complaining about a Maori doctor proves your racist lack of understanding about how healthcare is provided under the auspices of the Maori world view.
If this sounds bizarre, read David Round’s nearby piece again.
Bizarre IS the new normal.
We must not allow this bizarre new normal to bed in.
What we need is not just a remade bed, but a complete change out of the dirty linen, and disinfection of the entire room.
Andrew Dolittle - what more can be expected from a rabid unionist lacking even a basic concept of either business or healthcare. I predict another Pike river like debacle with this man involved. In fact the Labour party is so bereft of any talent that I despair for the potential damage that they will do to NZ between bow and when they get booted out next year.
The reluctance to allow overseas in nurses to relieve the chronic shortage of staff maybe because they are not brainwashed into the maori world view as required by our nursing system.
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