Dunne Speaks: Ministry Of Health Needs Better Day-to-day Leadership
Over the last year there has been a series of official criticisms of the performance of the Ministry of Health. While some relate specifically to Covid19, others reflect upon the wider role of the Ministry. Nevertheless, the breadth of the criticisms should be of serious concern. Yet they seem to be water off a duck’s back.
In the early stages of the pandemic the Crown Law Office advised the government that the first nine days of the Level 4 had been technically illegal because the Ministry had used the wrong legislation to impose it. That oversight was corrected by emergency legislation that was rushed through Parliament shortly afterwards.
The Public Service Commission’s investigation into the disclosure of sensitive personal information by Michelle Boag and then National MP Hamish Walker found that although the disclosure itself did not come from the Ministry of Health, “the policy around the security of personal information within the Ministry of Health could have been tighter and the agency should have reviewed this earlier.”
In December, the report from Sir Brian Roche and Heather Simpson of the COVID-19 Surveillance Testing Strategy advisory group into the management of Covid19 testing in the community and at the border was strongly critical of the Ministry for bad communication about the criteria for testing, and for keeping Ministers in the dark about concerns being raised by other agencies. That led the government to inject a further $2.8 billion into keeping current border controls and isolation facilities operating effectively until June 2022.
Last month, the Auditor-General released a critical review of the government’s vaccine roll-out plan being managed by the Ministry, outlining several shortcomings, including adequacy of supply, whether there were sufficient vaccinators, problems reaching remoter communities and confusion among district health boards. He recommended the Ministry should “get moving” on the “non-regulated workforce-non-medical workers” to be trained to immunise. There is no evidence that is happening, with the vaccination programme still being centrally organised through district health boards, with insufficient medical practices and other community health providers being utilised. The Auditor-General concluded there was a “significant risk” the vaccine roll-out would not be completed on time, despite continuing claims from the government that it is presently running about 10% ahead of schedule.
Clinicians in Dunedin last week expressed concern that the country’s vaccine supplies were running down “with not much transparency from the Ministry of Health regarding vaccine availability”. Earlier, the Covid19 Response Minister had blamed the looming shortage of vaccines on the fact that the vaccination programme was going so much better than expected. Yet, at the same time, there have been reports from around the country of key target population groups still waiting for vaccinations which are overdue. The Southern District Health Board said it was slowing its vaccination programme to protect its stocks until more vaccines became available.
The management of the vaccination programme has become a weeping sore, with the Ministry increasingly looking not up to the task of ensuring the original intention of New Zealanders being fully vaccinated by the end of the year will be achieved, let alone of our ever being at the head of the queue as was so falsely promised by Ministers just before the election last year. There have clearly been faults in the vaccine ordering process, with the Ministry’s expectations of the ease with which a smooth supply line would be ensured now looking hopelessly naïve.
But it is not only on the management of the Covid19 response that the Ministry has been found to be playing games with Ministers and the public when it comes to sharing information about what is going on. Last week the Public Service Commissioner slated the Ministry over its handling of a report on the state of mental health in New Zealand. The report had been released to the public but in a heavily edited and redacted form, leading the Commissioner to strongly criticise the Ministry and observe that its handling of the report had damaged its reputation with the public.
The buck for all these failings rests with two people – the Minister of Health and the Director-General of Health. While the Minister is responsible overall to Parliament and the public for the state of the country’s public health, the Director-General is in turn responsible to the Minister for the performance of the Ministry of Health in delivering the government’s key policy objectives.
In this instance, the primary responsibility for both the Ministry’s failings in the first place and for subsequently putting them right rests squarely with the Director-General. He alone is responsible for the operational conduct of the Ministry on these matters, whereas the Minister’s responsibility is to hold him to account for what has happened.
Although the Director-General’s accountability is to the Minister of Health, he has been reporting to the Covid19 Response Minister on Covid19 matters, thus splitting the responsibility between the two Ministers. It appears this split has complicated the accountability process somewhat which may partially explain the gaps that have occurred.
The problem is further compounded by the high positive public profile the Director-General has been allowed to develop during the Covid19 response. Not only has this made it more than likely that he has taken his eye off the ball on some of the more basic issues he is responsible for, but also has given him a level of public immunity to any Ministerial rebuke. (Remember the criticism this time last year when the then Minister of Health was roundly attacked for his apparent temerity in “throwing the Director-General under a bus” over failures to manage the border control system properly.)
Yet none of this excuses the Ministry’s day-to-day failings. Notwithstanding the extraordinary impact of Covid19, the Director-General’s primary responsibility remains unchanged from what it always has been – to ensure that the Ministry is fit for purpose across all its different areas of responsibility at all levels, now including Covid19, and able to deliver the government’s policy objectives. While his rapport with the public and positive media profile are additional positive attributes that can help the government in the promotion of its various health messages they are not substitutes for his basic role of running the health system effectively.
It is up to the Minister of Health, bolstered if necessary by the Public Service Commissioner, to ensure the Director-General provides the professional leadership and day-to-day management the Ministry needs to function effectively.