Widening Gap Between Health System Leadership And Health Workforce

Saturday, 3 May 2025, 6:56 pm
Opinion: Ian Powell

When I reflect on my involvement in Aotearoa New Zealand’s health system over the past three decades plus, mainly as a union leader but more recently as a health commentator, I think about key indicators of whether the system was functioning well or not.

A defining indicator was the nature of the relationship between the respective cultures of the system’s top leadership (located in central government) and its health professional workforce (particularly those at the diagnostic and treatment frontline).

Emergence of ‘vertical managerialism’ leadership culture

My overall assessment was that the gap widened in the 1990s due to the embarking on an ideologically driven endeavour to base the public health system on business competition rather than cooperation.

In the 2000s the gap narrowed with a return to cooperation as the driver. However, it began to widen again in the 2010s with increased central government control coupled with relative underfunding (light austerity).

This widening accelerated with the restructuring in 2022 replacing the longstanding principle of subsidiarity (things should be decided locally except where it made better sense to make them centrally) to vertical centralisation.

Acceleration allowed a new leadership culture to flourish – ‘vertical managerialism’ (my descriptor but, for better or worse, there is no patent).

Health professionals to health bosses – please stop the spin

The gap between leadership rhetoric and frontline reality is best illustrated by the spin of the former. I discussed this last year (10 August 2024) in a post on this blog:      Health professionals to health bosses – please stop the spin.

My opening two paragraphs were:

It is difficult to think of something more hazardous in Aotearoa New Zealand at the moment than the parlous state its public hospitals are presently in.

Aside from patients, those most directly affected are their Health New Zealand (Te Whatu Ora) employed health professional workforce.

I then referred to:

… the neglect by successive governments of the detrimental effects of the combination of increasing acute demand (growing at a higher rate than population growth) and severe workforce shortages across the full health professional spectrum.

After identifying the emotional stress this was causing health professionals, including fatigue and burnout, I added:

… this multiple badness is made even worse by the non-stop attempts of their political and bureaucratic leaderships to respond with unadulterated spin in pursuit of damage control from media scrutiny and public wrath.

This disingenuous and demoralising spin continues to be undiluted by empirical expert evidence to the contrary. Or to put it another way, the spin is undiluted by the truth.

I concluded by quoting a medical specialist who asked for the health system leadership to please stop the spin. My translation of this plea was:  

Overworked and fatigued medical specialists and other health professionals working in very stressful and injurious circumstances and knowing the harm being done to patients is bad enough.

But to then have those with much less accountability diminish their concerns and anxieties with calculated spin is terrible.

I closed off my post with:

Bridge the gap between the “upper echelons of management” and those at the patient frontline; don’t widen it.

The damage of ministerial “fake news” and Trumpian adaptation politics

Unfortunately, rather than bridging the gap, new health minister Simeon Brown is continuing to widen it.

The most vivid example of this was his extraordinary public statement that the severe shortages that those at the diagnostic and treatment were experiencing daily was “fake news”.

This could not have contrasted more than his immediate predecessor Dr Shane Reti who, on more than occasion, had publicly stated that these shortages were the biggest crisis facing the health system.

Compounding the Minister’s negative approach was his subsequent endeavour to silence population health specialists from providing inconvenient advice.

I discussed this adaptation of Trumpian leadership culture further in Otaihanga Second Opinion (31 March): Trumpian health leadership.    

This blunt silencing caused shockwaves not only in the population health field but across the much wider health professional workforce. It was an inadvertent but timely reminder of the union adage: an injury to one is an injury to all.

The loss of political capital and credibility with the health workforce that Brown’s dismissive retorts created cannot be underestimated. It will not be forgotten and undermines his ability to be a good custodian of the health portfolio.

Gisborne Hospital experience

Throughout the country there are numerous cases of serious situations where affected health professionals say one thing (aka the truth) and health bosses say the opposite (aka spin).

Newsroom’s Marc Daadler highlights this well in his 23 April article on senior doctors disputing inaccurate government claims over addressing shortages at Gisborne Hospital: Doctors dispute government’s figures at Gisborne Hospital.

In response to earlier reports of severe senior doctor shortages at the hospital and the denial of a crisis by Health New Zealand, Daadler investigated the claim that the Government was bringing in the “cavalry” with eight new doctors starting in the past eight months and 11 more on the way. This was called an “influx”.

The backstory to the article was that Gisborne’s senior doctors had written twice to the Prime Minister and Health Minister (August and March) advising that more than a third of their positions were vacant.

Consequently, “…clinics would have to start shutting down if a hiring surge wasn’t launched immediately.” They pleaded for “intervention.”

Their first letter (last August) advised the Government that:

Gisborne Hospital is on the brink of collapse and needs immediate intervention from government to safeguard our community … We are nearing a crisis point with current staff where they can no longer provide quality services in our institution and a mass exodus may occur. Every service is affected, and the very viability of our hospital is threatened,” the doctors wrote in the first letter.

Seven months later, they wrote that:

Harm to our patients will be inevitable. This is happening on your watch. We warned last year, collapse was imminent without urgent action. We are still waiting for someone with the requisite power and political will to take responsibility for fixing it.

Only one problem with cavalry influx claim – it is wrong!

There is only one problem with this cavalry influx claim. The hospital’s senior doctors revealed that there had been just one new permanent doctor starting since August, not eight. It didn’t “match the reality on the ground”.

Further, since last August there had been “multiple resignations” leading to an even higher vacancy rate.

Of the claimed eight new senior doctors, two were already employed at the hospital and had been counted as new hires due to contract changes, and five were on fixed-term contracts scheduled to end soon.

Of the claimed 11 new hires on the way, one was the single permanent position who had already started (ie, double-counted), two had delayed their start date indefinitely, four were fixed-term rather than permanent positions, one had withdrawn the application, and one was scheduled to start in August 2026 (no, the year is not a typo). Only one new permanent hire was expected to start in the next six months.”

No wonder Dr Alex Raines, speaking for the Gisborne senior doctors, said:

How do you think it feels to reach out for help in a crisis and receive a response that uses this kind of inaccurate and misleading information as the basis for denying the existence of the crisis?

Indeed, how can one not feel like this; when spin is blatantly used to deny an inconvenient truth from those responsible for the diagnosing and treating patients whose daily reality is that their health is being increasingly harmed (and worse) by this commitment to spin.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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