A leaked memo, reports of a strained relationship, and questions over what it all means for frontline services. Stewart Sowman-Lund explains the state of Te Whatu Ora in today’s extract from The Bulletin.
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Breaking point
Behind the scenes drama at the country’s health agency has spilled into the media, with tensions emerging between the newly appointed government commissioner and the existing chief executive. In an extensive report yesterday morning, Newsroom Pro’s Jonathan Milne first revealed details of a “fiery” meeting led by Te Whatu Ora leadership, and attended virtually by chief executive Margie Apa, in which 90 staff were told of potential wide-ranging cuts to roles across the country, including specialists and nurses. Commissioner Lester Levy was not in the meeting and was unaware of what was being discussed but later issued an internal statement, which was quickly circulated in the media. In the memo, Levy hit back at the supposed “cost savings” that had been discussed and said: “For the avoidance of doubt, what was presented is in direct conflict with our thinking and should be dismissed.” According to Milne’s report, tensions between Levy and Apa were now at “breaking point”.
The chief and the commissioner
It’s extraordinary to see such direct conflict between a commissioner and a chief executive, but it points to some of the teething issues as the mega agency undergoes a revamp. We’ve talked a bit about this in recent weeks, but here’s a brief refresher. Less than a month ago, the health minister Shane Reti confirmed the remaining board members at the health agency would be sacked and replaced by a commissioner, Lester Levy. It followed concerns over the state of Health NZ’s books, with Reti revealing the agency was overspending by $130m a month. But both Reti and the prime minister Christopher Luxon maintained there would be no impact on frontline services, despite recent reports of hiring freezes.
While there was no longer a board, the existing chief executive, Margie Apa, remained in her role. Apa has been with Health NZ since it replaced the country’s DHB network in 2022. At the time, in a wide-ranging interview with The Spinoff’s Toby Manhire, Apa was frank when discussing the health sector’s struggles post-pandemic. “We do not have enough health workers and we need more. We need to be investing in our workforce to develop the skills that they feel can add value to the care they provide.”
Are frontline roles safe?
The presentation delivered by health bosses suggests the agency was working to make wide-ranging cuts, but Levy, in his memo, expressly ruled out changes to frontline staffing. The government has been very open that it’s unimpressed with the performance of the health system, accusing Te Whatu Ora of being burdened by bureaucracy in the form of “14 layers of management” (a claim that opponents said wasn’t true), but has also promised critical services are safe. In recent weeks, there have been reports of telehealth services being used in hospitals due to staff shortages, while this in-depth piece in The Press signalled the health system was on the brink of collapse. Just yesterday, The Post reported on the uncertain future for major health projects in the capital.
Apa, reported Marc Daalder for Newsroom last month, said that the health agency’s poor finances were in part caused by a successful hiring drive for nurses as opposed to backroom staffing. This piece in The Conversation argues that “overspending” isn’t to blame, as asserted by the government, but historic underfunding that needs to be corrected.
Where to from here?
Things are only just beginning. In a speech in downtown Auckland yesterday, as reported by the Herald’s Nicholas Jones, Levy warned that an urgent overhaul of the health system would be far-reaching. “We have to face some very strong medicine as an organisation,” he said. Levy didn’t set a timeframe for this, or provide a lot of detail about what it may involve, but said the road ahead would be a challenging one. As The Post reported, Levy did not take questions from media after his speech.
There could be more to come in the aftermath of the leaked presentation, too. Apa and Levy fronted a joint press conference the day after the board was dismissed, reported the Herald’s Isaac Davison. Then, just a few short weeks ago, Levy said he had confidence in Apa. In Milne’s report for Newsroom yesterday, it would appear that confidence is slipping. “There will be consequences,” said Levy. “I have spoken to Margie as the chief executive making it very clear this is unacceptable and is not to be ever repeated.” The Bulletin asked Shane Reti for his response, too. He sided firmly with the commissioner, saying he was disappointed in how the material had been communicated and reiterating that “these reforms are looking to increase frontline staff, not cut frontline staff”.