Dr Richard Frith is a semi-retired neurologist and clinical neurophysiologist in Auckland. He has held clinical leadership roles in healthcare in New Zealand and Australia.
OPINION
The appointment of Professor Lester Levy as commissioner in place of the Health NZ board should bring joy tothe hearts of all of us who have been concerned about the direction the centralised health service has been taking in the past few years.
In this sort of situation a “benign dictator” is much more likely to be successful than a disparate group of board members with different levels of experience, agendas, and political leanings.
I have known Lester Levy for more than 40 years. While he has some detractors, he is intelligent, competent, a great leader, and has managed major change at hospital and district level in the past. He has also been successful in his other business and academic ventures.
I think if he has the appropriate level of support he will have the ability to turn Health NZ around. This will be a mammoth task, considering the organisational and financial mess Health NZ is in. Hopefully, he has the fortitude, and the political backing, to achieve success.
Professor Lester Levy is now the sole commissioner governing Health NZ for the next year. Photo / Dean Purcell
To support these - enhancing primary care, rationalising access to secondary and tertiary healthcare, rationalising tertiary and quaternary healthcare provision, addressing clinical workforce issues, central procurement of equipment and medical supplies, a single national electronic clinical record system, reduction in duplication in non-clinical areas, and clinical input into decision-making at all levels - will require several changes.
Ensure that the most senior leaders are of the highest quality and competence. I understand the difficulty in attracting the very best people to these roles, because health is often seen as a poisoned chalice, and the salaries are not competitive. With a few exceptions, none of the senior team would be employed by any New Zealand commercial entity of similar size to Health NZ. Health needs a chief executive from the Rob Fyfe or Ralph Norris mould. The other roles such as HR, finance, communication etc should be of a similar calibre. It may need a few salaries close to market rates and encouragement that taking on these roles could make a major difference to New Zealand healthcare, for appropriate people to be attracted to these positions.
Move as quickly as possible from the current centralised system to a regional system of healthcare provision, with devolution of most of the activities currently centralised, to the regions. Perhaps dusting off the Heather Simpson report could be a good start.
Rapidly address workforce issues. While it is said “frontline” recruitment and staffing have not been affected, this is clearly not correct. The system has become constipated. The extraordinary situation where one of the very senior leaders in the organisation insisted on signing off every single appointment from cleaner to doctor in every single hospital, was a good example of micromanagement, lack of competence, and lack of trust in those in the regions.
Substantially reduce the number of duplicated positions that have occurred with the “reorganisation”. The “consultation and reorganisation” process has been sluggish and misdirected, has left many competent and valuable employees uncertain about their futures, has cost a vast amount in external consultants, and has resulted in unnecessary restructuring of systems that were already efficient and effective.
Continue moving towards cost savings in procurement of equipment and supplies, on a national basis.
Work hard to increase clinical input into decision-making at all levels. Lester Levy knows full well how important this is. We now have a good example, in Auckland, of a chief executive who is a clinician, who is clearly competent, respected, and very likely to be able to make the changes necessary as we move ahead. This could undoubtedly be duplicated in other regions.
Manage expectations. Health will be a never-ending drain on any budget. New Zealand simply cannot afford some of the healthcare that is provided in other countries, and it certainly should not be driven by pressure groups or politicians.
Work hard to improve morale. Even in wartime, where the circumstances are very dire, good leaders can bring out the best in people. Lester Levy knows how important this is, and I expect he will be able to communicate his effectiveness and enthusiasm early during his appointment.
There will be many challenges ahead, and, without doubt, there will be some missteps, but with political will and leadership strength, we might start to achieve a healthcare service of which we can all be proud.
