A fleeting health system consensus

Last week I published in the Victorian University hosted Democracy Project the second part of a two-article series of the escalating clash between the Ministry of Health (MOH) and Canterbury District Health Board (CDHB) in the context of the recovery response to the earthquake devastation of 2010-11 https://democracyproject.nz/2021/05/19/ian-powell-a-very-bureaucratic-coup-part-two/.

This was largely a leadership culture clash between an evolving MOH culture based on command and control and a more engagement based CDHB culture. What has not always been appreciated was that during the decade long escalation there was a period of promising consensus. It only lasted around a year so if one blinked one could be excused for missing it. But real and genuine among many it was.

In the lead-up to the 2017 general election the opposition Labour Party had rightly been highly critical of MOH’s acrimonious and deteriorating relationship with CDHB. Strongly supportive of CDHB, Labour committed to turning this deteriorating relationship around.

The way forward

Honouring Labour’s election commitment incoming Minister of Health David Clark appointed Garry Wilson (a business consultant) to independently facilitate a process to reconcile the past bitter differences. This led to a report submitted to Clark in April 2018 known as the Way Forward Report.

At the time Ernst & Young (EY) senior partner Stephen McKernan was the Interim Director-General of Health following the resignation of Chai Chuah earlier that year. McKernan had been Director-General for four years in the mid to late 2000s.

The report’s analysis of CDHB’s unique financial circumstances arising out of the earthquake devastation was consistent with earlier external reports.  Wilson outlined a pathway for CDHB and MOH to address the impacts of the earthquakes on CDHB’s infrastructure and operating expenses.

The report described the challenges facing Canterbury as different from the other 19 DHBs. They were “complex, substantial and far reaching.” The “…unique capital redevelopment needs of the CDHB and increasing capacity constraints…” were emphasised.

McKernan’s ‘high praise’

In June 2018 McKernan on behalf of MOH and then CDHB Chair John Wood put out a joint statement which among other things described “the response of Canterbury DHB to New Zealand’s largest natural disaster has been exemplary despite needing to manage some of the extreme challenges faced by any organisation in NZ”.

Further, “The performance of Canterbury DHB and the wider Canterbury Health System has been everything that could be expected from a high performing DHB…” “Canterbury’s patient demand modelling was appropriate and the bed management functionality is the best we have seen..”

Wood and McKernan then emphasised that “It is important that the outcomes from an integrated healthcare response in Canterbury are captured as there are many lessons for both New Zealand and Internationally ….”

Such high praise from McKernan as Interim Director-General makes his subsequent lead role on behalf of EY business consultants in doing a hatchet job by misrepresenting nurse staffing data on the financial acumen of CDHB’s senior management team an astonishing turnaround.

The Way Forward Report was agreed with McKernan and subsequently his successor Ashley Bloomfield who commenced as Director-General on 11 June 2018. In December 2018 the Ministry released a media statement positively reaffirming support for the approach. There was now consensus between the Ministry and CDHB but this unexpectedly proved to be short-lived.

S-bend back to command and control

Regrettably this December statement marked the culmination of this consensus that was a substantial achievement and offered so much that was positive. Minister Clark’s laudable objective and integrity were subverted by those able to exploit his lack of a political nose.

The new-found collaborative relationship was replaced by a return to MOH’s adversarial command and control approach which arguably was more vicious than it had been before the 2017 election..

It meant abandoning the consensus reached over the earthquake recovery being the driver of CDHB’s worsening financial position to a MOH led attempt, using Crown Monitor Lester Levy and EY business consultants, to smear the financial management of CDHB Chief Executive David Meates and his senior management team.

Health systems are labour intensive, passionate and highly complex. They depend on human relationships. Inject poison such as a command and control leadership culture into that relationship and the outcome is inevitability conflict escalation (or alternatively suppression) and dysfunction.

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