Dr Bryce Wilkinson: Replacing Health NZ board offers glimmer of hope

In a dramatic move this week, the government replaced the board of Health New Zealand (Te Whatu Ora) with a commissioner.

Dramatic but not much of a surprise. Last November, health expert Ian Powell wrote, “The health system is in a state of chaotic crisis (carnage is what it often feels like to those at the clinical frontline).”

He thought that if the new Minister of Health did not decisively change the board’s direction “nothing would change”.

Take a bow then on this first step, Minister Reti.

Brian Easton: There Are Wider Lessons To Be Learned From The Failures In The Management Of The Health System

It is the professionalism – competence and integrity – of the doctors, nurses and technicians who provide the care which obscures the managerial failure.

The column-blog, Otaihanga Second Opinion is compulsory reading for anyone interested in the health sector. It is written by Ian Powell, who was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years (until December 2019) and he has an intimate knowledge of the sector and excellent judgments.

Ian Powell: Our scary public hospital crisis+

On 9 February 2023, TVNZ’s 1News revealed some data that should alarm us all: that our hospitals had hit 100% occupancy more than 600 times in 2022. That is, on average, each day, roughly two public hospitals around the country were running at an occupancy higher than they were resourced for.

If anyone doubts that our public hospitals are in crisis, this fact alone removes any doubt. Arguably it is worse than crisis – it’s a scary crisis +!

Ian Powell: Colossal ‘porkies’ and band-aids don’t’ make a health workforce plan

On 1 August Minister of Health Andrew Little announced what he described as the start of a plan for the beleaguered workforce in Aotearoa New Zealand’s health system: Government’s 5 year late health workforce announcement.

In October 2017, when Labour became government with its two coalition parties, it inherited a health workforce crisis from the previous National-led government. As a consequence of a high level of inaction, partly due to a misplaced faith in restructuring as the solution, the situation has unfortunately further deteriorated.

Ian Powell: What happens when a health minister loses workforce trust and confidence

On 4 July Stuff published my opinion piece on the angry behaviour of Minister of Health Andrew Little in publicly disparaging dedicated people and organisations strongly committed to the provision of accessible quality healthcare: Health Minister’s angry behaviour denying the obvious.

I referred to his derogatory comments on the “nominal leaders” of primary care (essentially general practice representatives), rural general practice ownership, New Zealand’s pharmaceutical purchasing agency Pharmac, Waikato emergency medicine specialist Dr John Bonning (also President of the Australia and New Zealand College of Emergency Medicine), and finally the NZ Nurses Association (NZNO).

Ian Powell: The return of 'Angry Andy', the Health Minister who is denying the obvious

When he was elected leader of the Labour Party following the 2014 election defeat, the National Party in government detected something in Andrew Little’s personality, leading him to be nicknamed “Angry Andy”.

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.

Ian Powell: Is the health system an electoral Sword of Damocles for Labour?

The legend of the Sword of Damocles – about the imminent and ever-present peril faced by those in positions of power – is relevant to voters in the 2023 general election, when they contemplate the Labour government’s stewardship of the health system.

In 2017 the Labour-led Government inherited a health system in crisis, with severe workforce shortages.

While this was an inherited, the Government has largely ignored it. Workforce shortages now range between ⅕th to ¼ depending on the occupational group. Even before the pandemic these shortages were impacting severely on access to planned surgery and other treatments, overcrowded emergency departments, availability of hospital beds, and compromised capacity to diagnose patients in a clinically timely manner.

Covid-19 accelerated this, but did not cause it.

The Government’s response was transparently pathetic. In 2018 it trumpeted the formation of a committee; in fact, it was a reconstituted committee with less authority than its predecessor.

Ian Powell: I’m sorry I haven’t a clue; parody in action

I’m Sorry I Haven’t a Clue is a famous BBC radio and television show, billed as the antidote to panel games and launched in 1972. A parody of panel shows, it features two teams of two comedians each being given “silly things to do” by a compere.

The show is still going strong, and is now being replicated in the restructure of primary and community care in Aotearoa New Zealand.

This restructure is part of the Government’s wider restructuring of the health system including the abolition of district health boards (DHBs) which are the statutory points of connection between central government and the local design, configuration and delivery of health services.

Ian Powell: Baldrick’s ‘cunning plan’ - a health restructuring without a transition plan

On 21 April 2021 Minister of Health Andrew Little announced a major restructuring of Aotearoa New Zealand’s health system involving three main changes to take effect on 1 July 2022. Better understanding the third of these changes is helped by drawing upon Baldrick of the Blackadder television comedy.

The first two changes are commendable; the establishment of the Maori Health Authority (MHA) and the new crown public health agency (located within the Ministry of Health). They both have the potential to sharpen the effectiveness of addressing the impact of external social determinants of health, wellbeing, and access to quality patient care treatment.

Establishing these two new entities does not of themselves disrupt or destabilise the health system. Both new entities could established without any other restructuring, aside from transferring some functions to them presently performed by the health ministry.

But the third change does disrupt and destabilise the health system; the abolition of district health boards (DHBs). DHBs are the ‘point of connection’ between central government and healthcare provision and treatment both in communities and public hospitals.

Ian Powell: An unresponsive Prime Minister and Health Minister to a best endeavour

I have expressed my concerns in these postings and other media outlets about the Government’s decision, without mandate or engagement with the health sector, to abolish district health boards (DHBs) in Aotearoa New Zealand’s public health system (thereby abandoning the longstanding democratic principle of subsidiarity between central and local government).

I have also expressed concern about the Government’s increasing drift towards a laissez-faire pandemic response since last October.

On 2 February I blended both concerns together in an email to Prime Minister Jacinda Ardern arguing that it was dangerous to disestablish DHBs in the midst of a pandemic. These concerns have subsequently greatly intensified with the onslaught of the highly transmissible Omicron variant.

In addition to throwing our health system, both community and hospital, into crisis it has led to a massive increase in mortalities; from around 50 prior to this year (over 21 months) to a further nearly additional 600 deaths to date this year.

Ian Powell: Integrity and vaccine production: lessons for New Zealand

Reputable medical journals such as the British Medical Journal (BMJ) are invaluable not just for doctors but for those that observe health systems and policies, both of which are intertwined with the practice of medicine and science.

Nowhere are these journals more important that in the understanding and experience of the production of antiviral drugs (medication used for treating viral infections by inhibit their development) and vaccines. This is more so because production is overwhelmingly dominated by large pharmaceutical companies (often referred to as ‘Big Pharma’).