Health New Zealand bosses scapegoat their workforce

Since July 2022, with the coming into force of  the Pae Ora Act, Health New Zealand (HNZ) is responsible for managing all health services including (a) hospital and specialist services and (b) primary and other community care.

It is an amalgam of the abolished district health boards (responsible for the health of geographically defined populations) and the funding and planning functions of the Ministry of Health.

Te Whatu Ora: the weaving of wellness

Whenever discussing Health New Zealand I have referred to it interchangeably with its Māori name, Te Whatu Ora.

In fact, I’ve referred more to its Māori rather than English name. The reason, in part at least, it the beautiful meaning of Te Whatu Ora:  ‘the weaving of wellness’.

In the context of Aotearoa New Zealand’s public health system words involve bringing two or more strands together to weave a basket; a basket of life.

Although I’m highly critical of the health restructuring under the previous Labour government, as a name Te Whatu Ora can’t be faulted.

Scapegoating workforce demeans HNZ’s Māori name

However, given its subject matter, I’m sticking with Health New Zealand for this particular blog. Its recent behaviour demeans its Māori name.

Rather than weave strands together this behaviour involves scapegoating the most valuable asset that HNZ possesses; its workforce.

Scapegoating is the act of blaming a person or group for something bad that has happened or that someone else has done. Examples include blaming immigrants for a country’s economic problems and blaming coaches or captains for a sport’s team’s poor performance.

Scapegoating precursor: a ‘fish rotting from its head’

Health New Zealand’s national operational leadership has just decreed that recruiting to fill all its staff vacancies or new positions, from cleaners and laundry workers to medical specialists and nurses, must now be approved by its national office.

This is an extraordinary position which makes a vulnerable workforce more vulnerable. Such is the level of fatigue and burnout arising out of the deadly vice of severe workforce shortages and rising acute demand, that it is critical that recruiting to fill positions is undertaken expeditiously.

The relevant expertise and expertise for making recruitment decisions in a timely manner resides much closer to where healthcare is provided.

A responsible employer committed to its workforce would not take this action. However, it is the action an insensitive employer living in an isolated bubble and consequentially divorced from workforce realities would take.

Waitemata Chief Medical Officer and cardiologist Dr Jonathon Christiansen gets it in one

It led a justifiably outraged Waitemata Chief Medical Officer, cardiologist Dr Jonathon Christiansen, to make the following erudite and biting comment in his regular newsletter to his medical colleagues:

Changes to delegations for recruitment to existing and new positions

The national directorate of Hospital and Specialist services has advised districts this week that, effective immediately, all recruitment for HSS staff (cleaners to senior clinicians) must be formally approved at the national office, whether that recruitment is to new positions or simply replacing existing positions that become vacant. 

 This directive beggars belief, and would have been suitable for release on Monday 1 April, where it might have been accepted in the spirit of foolishness the day is known for. Staff turnover in many frontline clinical (and non-clinical but essential – orderlies, cleaners etc) services can be significant (>10%), notice periods are typically only 4 weeks, and with 10s of 1000’s of employees nationally the logistics of this alone, let alone the rationale, are beyond my comprehension.

I am reminded of the Board Directors’ course I completed some years ago in Australia – a dead fish was drawn on the whiteboard at the opening lecture and remained there for the duration of the week’s residency. A visual reminder of the phrase variably attributed to an old Russian or Turkish proverb or to the writings of Erasmus: “A fish rots from the head”. 

 I’m reasonably confident that the number of HNZ staff, from cleaners to medical specialists, who disagreed with his critique could be counted on one hand (two hands at a push).

Is Health New Zealand a fish that rots from its head?

More scapegoating to come

Then, on 19 April, Radio New Zealand’s investigative journalist Phil Pennington broke a story about more widespread top-down controls from HNZ’s top leadership on its workforce: More extensive workforce measures by Health New Zealand revealed.   

There were 14 measures decreed, all exclusively in the interests of improving HNZ’s precarious financial position before 1 July. These measures included:

• Every shift should have two of its staff on leave (to reduce accrued annual leave as a balance sheet liability).
• No double-shifts (these are due to severe workforce shortages for which there is no planning to address).
• No new non-clinical staff commencing before 1 July (thereby putting more pressure on a fatigued and burnt out clinical workforce).
• Consideration of permanently removing vacant staff positions (fudging the data on workforce shortages).
• No backfill for staff on sick leave, excluding night shifts (placing more pressure on remaining overworked staff).

This is all about cost-cutting as part of a desperate HNZ leadership seeking a breakeven position by the end of this financial year (30 June). It is without regard to the extra pressure this will put on an already fatigued and burnt out workforce.

On 22 April Radio New Zealand reported efforts by HNZ to downplay the significance of these measures: HNZ downplay and nursing rebuttal.

Margie Apa: spoke from an isolated bubble divorced from workforce reality

This report included links to earlier Morning Report interviews with HNZ Chief Executive Margie Apa and NZ Nurses Organisation President Anne Daniels.

The differences between Apa and Daniels could not be more stark. The former was someone in an isolated bubble believing in castles in the sky.

Anne Daniels: spoke from the frontline reality

The latter was someone who understood intimately what it was really like at the frontline. The contrast could not be greater. They work on different planets.

Why

Why is HNZ behaving like this towards its overworked staff? The short answer is that it under strong political pressure to breakeven this financial year and it is scapegoating its workforce, which it considers to be a balance sheet liability.

Thomas Coughlan reported HNZ’s $1billion deficit

On 5 April NZ Herald journalist Thomas Coughlan covered the  report of the Health Select Committee on the performance of HNZ in its first financial year (1 July 2022-30 June 2023). This included the revelation a $1 billion financial deficit: $1 billion HNZ deficit in its first year.

HNZ top operational leadership’s jobs are on the line. If HNZ does not breakeven by 30 June then their future is uncertain. Few believe this objective will be achieved. Ironically HNZ’s leadership is not the reason for this financial position.

Instead it is a combination of poorly thought out restructuring by the previous government and increasing acute patient demand which is what the health system should be enabled to focus on.

There is simply is no excuse for scapegoating their workforce by treating them as a balance sheet liability.

Instead Health New Zealand needs to start weaving wellness for its own workforce, and quickly.

Most recent ‘Otaihanga Second Opinion’ posts

1. New hospital building trumps ‘Yes Minister’ hospital without patients – Otaihanga Second Opinion (wordpress.com)  Yes Minister hospital without patients   (18 April).
2. How to immobilise a health system’s primary statutory adviser and monitor – Otaihanga Second Opinion (wordpress.com) How to immobilise a health system’s primary advisor and monitor (10 April).
3. Time for Health Minister to step up on workforce crisis – Otaihanga Second Opinion (wordpress.com)      Time for health minister to step up over workforce crisis   (2 April).