10 minute read
A LEVY ON HEALTH
MATT SHAND, JOURNALIST
One week into his role as Commissioner for Health New Zealand, Lester Levy spoke to The Specialist about what he thinks success looks like reshaping Health New Zealand.
The new Commissioner for Health New Zealand says he will not waste time figuring out what went wrong with the previous board. He is simply going to play the cards he has been dealt and focus on fixing the financially dire situation.
The board of Health New Zealand was removed, and Lester Levy was appointed to the position of Commissioner in July by Minister of Health Shane Reti, after papers provided to Cabinet showed Health New Zealand was overspending by $130 million per month.
Extrapolated out, this represented a potential $1.4 billion annual deficit, and Prime Minister Christoper Luxon said Health New Zealand suffered from a lack of financial control and had “no great understanding or literacy around cash flow analysis whatsoever”.
“The board not being aware and not being financially literate, and not being able to get a financial picture in itself is a real big problem,” he added.
Members of the removed board included Vanessa Stoddart, Amy Adams and Naomi Ferguson, and doctors Curtis Walker and Jeff Lowe.
Levy’s appointment follows the Minister’s decision to appoint a Crown Observer to the Board of Health New Zealand in December last year. The Crown Observer’s role will also end now that Levy has been appointed.
As well as avoiding a potential deficit, Levy has set himself the additional challenge not to cut jobs that will affect frontline services will be affected. Levy says most of his cuts are aimed at management positions and he has specifically committed not to cut any SMO terms and conditions such as long service leave.
“The number of management-type roles has increased by about 2,500 since 2018,” Levy says.
“That is true. That’s where a lot of the numbers come up. At the moment we are trying to get the data and then begin the process.
“I have seen triplication and quadruplication of roles within Health New Zealand all over the show. I think when these organisations came together it would have been a good idea to get some coherence about that. You don’t need six people doing the same thing.
The targeting of management has already seen National Director Hospital and Specialist Services Fionnagh Dougan and National Director Commissioning Abbe Anderson lose their jobs.
The four Regional Director roles at Health New Zealand have been replaced by four regional Deputy Chief Executives, with three of the incumbents – Chris Lowry in Te Manawa Taki, Russell Simpson in Central and Ngarie Buchannan in Te Waipounamu (an interim Regional Director) – being overlooked for the new roles.
“It is extremely difficult to cut jobs,” Levy says. “I’ve been through this a few times before and, to be completely frank about it, you are never the same person afterwards.”
Data concerns create confusion
Levy has been tasked with cutting what the Government has called Health New Zealand’s “bloated bureaucracy”. However, Health New Zealand has proven a difficult organisation to take an axe to.
As many ASMS members can attest, staffing reports solely about SMO numbers are of variable quality and accuracy across the districts of Health New Zealand.
Levy says there are “many concerns” with the data he has access to and whether the data he receives is accurate.
“We have really had to dig deep, probably deeper than anywhere else, to make sure we have the right data and the data we’re dealing with is accurate.
“You can’t just push a button and get it. We’re looking at the entire structure and looking to get the right information before making decisions. Once we have the data we will be talking to staff and unions about the process [for redundancies] and that is where we will begin.”
Productivity top of mind
Levy is vocal in his belief that Health New Zealand can do better with the resources it currently has.
“Not everyone agrees with this, but I believe there is a lot more we can deliver with the resources we have got,” Levy says.
“People do not like to speak about productivity, but I do not just see productivity as a commercial or financial construct. I see it as a clinical construct.
“If we can get more out of the resources we’ve got, then we can accelerate this waiting time reduction and we can help people get to more services. And we can definitely achieve that.
“We need to transform this organisation into a health delivery organisation, get productivity up, empower the front line and ensure jobs support that effort. Health delivery is the main show in town.
“When I talk about that, I am not just talking about nurses, doctors and allied health, I am talking about the administrators in that front line – the electrician keeping the lights on and the cleaner. It’s all part of the front line. That’s what I want to power up.
“I think Health New Zealand looks more like a public bureaucracy sector organisation and it needs to be recalibrated so that it looks like a health delivery organisation.”
As well as management bloat, Levy wants to see better use of the locum workforce. When asked about the expenses of hiring locums to fill vacant positions, he says there needs to be reduced reliance on a contingent workforce.
“We have a very big budget for contingent workforce and that budget is being overspent quite a lot,” he says.
“We need to increase our permanent staffing, for senior doctors in particular, and reduce the reliance on locums. That is in all areas, not just the hard-torecruit areas. Maybe we have not been very good at doing this [recruiting] or maybe there are legitimate shortages, but this will be a big focus.”
Wait times and the return of targets
Another key focus for Levy is a reduction in wait times, in line with Minister Shane Reti’s national health targets. “I have always said the shortest wait [for a patient] is the safest wait,” Levy says.
“My priority is getting wait times down. We have national targets, and I know some people do not like targets. I never see targets as the end, they are the means to an end. The end is to have proper flow and managed demand across the health system.
“That is not just in the emergency departments. The ED is where it manifests the most. But we need to make fixes across the system. At the moment the system is very vertically siloed and that is unhelpful.”
Levy says his experience as a board member of Waitematā DHB from 2009, and chair from 2016, shows how targets can be met.
“When I was appointed in 2009 it was on the back of a very negative review from the Health and Disability Commissioner,” he says.
“It showed that people had come to harm and died as a result of being left in corridors. We were only at 61 per cent of our target. There was a lot of tension at the hospital and a lot of the advice I had from clinicians was to close down.
“We didn’t and we managed to open 24/7, which was a good day. We got over the 95 per cent target, and the thing I will never forget about that is the people who were working there, leading the change, were the same people, other than the odd one coming and going, that got the 61 per cent.
“They got to 95 per cent and kept it there. So, yes, this can be done and done by the same people. There are different approaches needed. We’re going to have a level of clinical involvement and engagement that has not been seen within Health New Zealand. I want to see all our major decisions made in the clinical frame of reference, and I will be getting groups together to help advise me as a commissioner because you cannot be a Lone Ranger. You need to connect with people.”
Perception versus reality
The same hospital he helped reach the 95 per cent target has since dropped below that figure and Levy admits it has gotten worse.
Is it truly possible to get more results from the same people when the health workforce is calling out the shortages, burnout and continued overwork?
“Sometimes perception is reality and sometimes it isn’t,” Levy says.
“Never before has there been so much money in the health sector. That’s a fact. Never before have we had so many FTEs as we have right now.
“Over May and June Health New Zealand hired 2,603 people, including 132 SMOs, 844 nurses, 70 midwives and 419 allied health workers.
“Now that is cold comfort for a particular area that is short staffed and can’t staff up. That’s why we want to push things much closer [to a regional model]. Then the management and clinical leadership understand what the problems are.
“What has also happened is the output has remained relatively stagnant. This is the productivity issue. We can and need to do more with the resources we have got. How do we make the work more seamless? How do we make it easier? I think we will get there with these targets.
“People say health professionals are resistant to change. I don’t believe that. I just think they are reluctant to change because they have had so many bad experiences.
“We need everything orientated to deliver our goal of being a health delivery organisation.
“We need to orientate towards the front line doing that and supporting them to do that. To not be so multi-layered and so complex.”
What will happen to the multi-layered aspects of the organisation that are deemed surplus to requirements?
“We’re looking for performance,” Levy says.
“If people do not perform, then the inevitable will happen. If people perform, then we will have confidence in them.”
What does success look like?
To Levy success in this role is seeing a health system that meets its targets, is financially sound and returns to a normal government structure. With just 12 months, initially, to achieve this, it is a tall order.
“A year is short,” Levy says.
“Commissioners are appointed and can be extended. We want to solve the financial problems. By the end of the first year I want to have solved a lot of the financial issues and be getting wait times down.”
Levy says there is no recruitment freeze and points to figures above showing increases in hirings.
“If there is a clinically vacant position it should be filled,” he says.
“If somebody is not filling it then we need to know about it. We are still open for business.”
Asked about a regional allowance for hard-tostaff locations, he is not against the idea.
“We need to pull every lever we can to ensure areas have the staff,” he says.
“People are entitled to live wherever they want. There are some good ideas about what can be done. We want to see regional services stronger, not weaker.
“If we had doctors we could put into these positions, we would have. I think this is where having clinicians involved in the organisational hierarchy is going to be important, as that is where we will find the innovation to change.”
Personal drivers
“What motivates me to do this work is that New Zealanders are waiting too long for health services – from the emergency departments, first specialist appointment and planned surgery.
“In my view the safest wait is the shortest wait. The priority for me, then, is to find ways to bring the wait times down.”
In regard to what went wrong with the previous board?
“I just have to take a constructive, positive approach and just deal with this,” Levy says.
“I’m not looking back. I’m not picking over the pieces. I’m not going to be criticising anybody. I’m just moving forward, playing the cards I have been dealt.”
