Former Te Whatu Ora (Health NZ) chair Rob Campbell addressed a New Zealand Women in Health gathering on Friday night where 90 clinical health professionals from around Aotearoa heard him speak.
My topic tonight is “The Health Services Emergency”
Thank you for the opportunity to be with you this evening. Given that over 80 per cent of the quarter million or so people working in the healthcare sector are women I am taking the liberty of speaking to you as representing the whole workforce. I am not sure that has always been the case in policy or practice but let’s start a new tradition.
It is opportune to be talking about the immediate future of the healthcare sector and the emergency it faces. I deliberately move on to the description “emergency” because the term “crisis” has become so worn in political discussion. It has come, perhaps lead by the “climate crisis”, to carry with it a connotation of longevity, helplessness and inaction.
Emergency seems to carry with it a higher call to action. That is what health services need now.
I had an email today from the Minister of Health Ayesha Verrall which I will read to you:
“Dear Rob, I hope that you are willing to put our little misunderstanding behind us. Things in the sector are very bad. I think it may even be an emergency though the Ministry continues to insist that everything is fine. Would you be willing to come back as my “independent health emergency advisor”? Not much point in rejoining the board which has little influence and Peter Hughes will not let you back into the public service anyway”.
I will tell you tonight what I would advise her in that role. Don’t bother with an OIA request, the email is imaginary.
For completeness I should add that I also had an email from Christopher Luxon. His read:
“Dear Rob, thank you for the plastic dog whistle which you sent me. I have been practising with it. My own dog “Doctor Shane” does not respond to it and I still have to go out each night to find him barking furiously at imaginary flocks lost down a gully off Molesworth Street. But our rich neighbours’ dog “David” responds immediately, comes and eats all our dog biscuits, pees on the carpet and disappears again each night. This stuff is harder than running an airline”.
Christopher is right.
Also just in is one from John Tamihere.
“Kia ora Rob. I regret that we cannot accept your application to stand for Te Pati Maori as health spokesperson. While you would add some diversity to our line up we have plenty much more skilled and experienced people in health services who are vastly under-utilised”.
John is even more right than Christopher.
And while Ayesha needs the advice she is about as likely to invite me to be a free consultant as she is to sack the numerous expensive ones who have and continue to mislead the health services.
The simple point is that there is an emergency in our health services. The current leadership of that service from the Beehive, to the Ministry, to Te Whatu Ora and even more broadly through the sector is failing to grapple with the emergency or even to effectively triage its complex presentation. Only those actively engaged in the heart of an emergency can effectively respond. The job of leadership is to empower and support them. I think they mostly know that and genuinely want to do so.
But some of what they need to hear is not all that palatable to them. The Minister found an effective way of cutting off my own warnings, but it is damn sight harder to cut off the warnings from you here tonight, as good a proxy for the health workforce as there is.
I am not an expert in health services. I had a role and I have an active interest. I failed in the role at Te Whatu Ora. I should have been far more disruptive and insistent on inclusive disruption than I was. By “inclusive disruption” I mean the promotion of a positive radical change process (which Pae Ora:Healthy Futures is as an aspiration) by empowering key actors in support of the change. Radical positive change will not occur by decree, by central plan, or dare I say it, by standard public service management process.
Incidentally is it not telling that the Minister “of” Health is the title? Why not Minister “for” Health. What a difference it would make if the Minister and Ministry and Te Whatu Ora saw their roles that way. As representative, advocate, and responsible “for” health. They might even actively pursue the many well known known public health, primary and hospital services and staff needs rather than spend their efforts defending the failure to do so.
I am not a health expert and do not pretend to be. Most of you are. One of the problems leading to emergency in our health services system is that too many people without genuine expertise and understanding, without genuine lived and worked experience, have had and retain too much influence. Too many consultants and officials and politicians (and yes, board members) who think they know best constructing plans for others to follow. Some of these are elegant and at some level many are sound and aspirational. But few are grounded in current genuine experience.
I learned that, not fast or deeply enough but learned, during my gig in health. It’s a long way to go if you want to rock and roll, as AC/DC told us, but it’s harder than you think. On the way you have to deal with what is there, not what you might want to be there,
There is no “google map” for you to follow in this emergency, Minister. You have to ask directions from those who live in it. What I set out tonight is just what I can hear from them, I hope you can hear it too.
The Immediate Emergency Response:
* Admit that there is an emergency, and describe what it is. Acknowledge all the pressure points and their impacts on staff and those who are or should be accessing the health services system. People respond to realism in emergencies much better than they do to pretence.
* Confirm the objectives of the Pae Ora reforms but acknowledge that delivery of these reforms is to work of decades, not a couple of years. Set aside for now any reports and plans and work flows which do not reflect the emergency or they will distract you and everyone else. The reforms provide a framework and long term plan but the emergency takes precedence. Some work can continue on the longer term matters on the side and I will refer to that but the “emergency response’ needs absolute focus and attention.
* Involve the professional, industry and union organisations in defining some precise emergency priorities across the system. Things which need to be done in 2023 and 2024. Get everyone committed to those and to accepting that many even strong longer term preferences will not be addressed in that time. Not over 100 actions for planned carer or even 24 for “winter”. All actions now should be for the emergency.
* Empower separate emergency executive leaderships for hospitals, funding of primary sector and capital works drawing on clinical and commercial expertise from inside and outside the sector with delegations to act on the precise emergency priorities, whether speeding, delaying or amending current activities but utilising present organisational structures wherever possible. Yes these structures need longer term reform but the emergency demands we just use what we have in the meantime.
* Make immediate decisions on equity and other pay and sector funding claims which show good faith, intent and market realism. Many of these are simply delayed inevitable costs, which have significant indirect cost impacts anyway.
* Fund this as Government would fund any other emergency of this magnitude.
* Activate an immediate and substantially stronger shift in emphasis and funding to kaupapa Maori health and social services in partnership with Whanau Ora and Te Aka Whai Ora.
It is quite unrealistic to expect the processes, structures, accountabilities, operating models and people from the past system to handle this emergency . You will have to instruct and require the board and emergency executive to cut through anything which is getting in the way.
This can only take place alongside and at the same time as the longer term work of the reforms. It is already apparent that there is a need to reset some aspects of that process. Being very clear about this is essential to acceptance of the immediate emergency plan.
These longer term actions include:
* Reset the “locality” process and its timing, drawing on the input of bodies like the PHOs, local authorities and the IMPBs together with the private enterprise and community and Maori providers setting the activity and geographic scope of the networks. Allow significantly more time for this than in the current legislation and plans;
* Require public and private hospital and specialist and ancillary service operators to agree a plan and the best mix of services between. Implement the plan then. There is currently no clear model of how this should work. Participants must set aside their sectional interests.
* Review the applicability of the current delivery, monitoring and approval structures to the reform objectives. This review to limit excessive bureaucracy and central control from delivery of services. Drive the review to clear conclusions and actions. People the review fully with those actively working in the various fields involved.
* Reset as “partnerships” all national primary sector arrangements with arbitrated funding outcomes not imposed ones.
* Establish an all of sector clinical governance board with representative membership alongside the operating board with significant influence over policy and delivery decisions.
Some of this formally cuts across the Pae Ora structure of separate delivery by Crown Entity just established last year. But frankly the way it all works so far is really no different to a Ministry and Minister controlled Government Department anyway. So you might as well use that, and the centralisation which has dominated actions so far, to deal with the emergency and allow time for more efficient and effective management structures to develop in tune with the longer term localisation objective.
So, Minister, I reckon this could still be done. It would make a difference. I think most people in the sector would respond to it positively. It would help dispel mistrust and despair. How could it be worse than they emergency we have?
At least I would not have to be answering imaginary emails.
Oh, and not by the way, insist on getting on with the Women’s Health Strategy. Make it realistic and implement it.
Rob Campbell is a professional director and investor. He is Chancellor at AUT, Chair of Ara Ake, Chair of NZ Rural Land and former chair of Te Whatu Ora