Latest news with #LesterLevy
Scoop
4 days ago
- Health
- Scoop
‘Slash And Burn' Increases Poor Health System Decision-Making: Witness Maternity And Gynaecology
In Aotearoa New Zealand's health system there are 36 branches of vocational (specialist) medicine registered by the Medical Council. These are called 'scopes of practice' which allow doctors to work independently of supervision (doctors with general scopes of practice require some form of supervision). Overwhelmingly these specialities have one or two names such as 'dermatology', 'general practice' and 'orthopaedic surgery'. Consequently, a speciality with 'and' between two words is unusual. Obstetrics and gynaecology (usually referred to as O&G) is an 'unusual'. They are somewhat like twins or close cousins. Whereas the former is obviously about birth, the latter involves the treatment of women's diseases, especially those of female reproductive organs. 'Slash and burn' strategy Like almost all the other vocational scopes of practice, O&G suffers from a crisis of severe workforce shortages due the political neglect of successive governments. Cutting maternity beds at Wellington Hospital is part of a wider 'slash and burn' strategy led by Health New Zealand (Te Whatu Ora) Commissioner Lester Levy over the past 12 months. I have discussed this strategy previously in the context of health IT (15 December): Slash and burn health IT strategy. I have also discussed it in the context of gutting specialised health teams (22 January): Gutting specialised health teams. The maternity service crisis is national, not just local. By way of example, Hawke's Bay Today (8 July) reported that more than 900 women in Hawke's Bay are waiting to see a gynaecologist, many of them facing 'unbearable pain': 900+ Hawke's Bay women suffering unbearable pain. 'Slash and burn' leads to poor decision-making On 7 July a story by health journalist Ruth Hill on Radio New Zealand's Morning Report revealed a shocking new development: Cutting maternity and gynaecology beds in Wellington Hospital. Health New Zealand was planning to cut beds from its gynaecology and maternity wards in Wellington Hospital in a trial aimed at making more room for patients from its overcrowded emergency department. While management claimed that the maternity wards often had empty beds, those with the experience and expertise to know more (O&G specialists and midwives) disputed this. Instead, they feared there would be huge pressure to discharge mothers and newborns too quickly. The Midwives Union MERAS (Midwifery Employee Representation and Advisory Service) Co-Leader Caroline Conroy said Wellington Hospital's maternity unit was 'one of the busiest in the country'. Further: The monthly stats we get at staffing meetings show the bed utilisation is over 100%. So it's a really busy unit. She also made another interesting observation with her suspicion that the Government's health targets for emergency wait times and elective surgery were squeezing capacity elsewhere. This is one of the problems when they set targets, and we've seen this in the past – when the focus and funding goes on those targets, and other services are not given priority. O&G specialists college slates maternity bed cuts Meanwhile Royal Australian New Zealand College of Obstetrician and Gynaecologists vice president Dr Susan Fleming said, in the above-mentioned Ruth Hill piece, a further squeeze on maternity resourcing was disturbing. Demand in obstetrics is not predictable. Even 'elective' procedures like caesareans are not truly elective. You can push them back hours or even days sometimes, but you don't have a lot of flexibility. When there's a peak of demand around acute presentations in labour and a demand for inductions and caesarean sections, then there's no flex capacity, and then the only thing you have is to discharge women from the post-natal wards early. Further: …my understanding is that most maternity units across New Zealand are still struggling with midwifery resourcing, and particularly with the smaller units, with obstetric resourcing. The following day (8 July) Morning Report covered further staff distress over the maternity bed cuts: Maternity staff beg Health NZ not to cut beds. Inglorious backdown Former British Labour Prime Minister Harold Wilson is known for several 'pearls of wisdom'. One which is often repeated is that a week is a long time in politics. This is equally so with health systems; sometimes only a couple of days. By late 8 July Health New Zealand was reporting a complete backdown by reversing its decision to cut maternity beds. This was covered the following day by Morning Report: Backdown. Also see later in the programme the item by senior reporter Natalie Akoorie: Senior doctors welcome U-turn. This backdown was a huge embarrassment for the national health bureaucracy statutorily responsible for Aotearoa's planning and provision of healthcare. Rather than management on the ground, however, prime responsibility rests with the poor political leadership of the health system by the current and previous governments. This was reinforced by Commissioner Levy's destabilising 'slash and burn' strategy coupled with Health Minister Simeon Brown's simplistic soundbite advocacy. Take-home points Health New Zealand was created in 2022 by an unwanted restructuring and has been internally restructured ever since. Instability and all that consequentially follows have been the inevitable outcome. A big part of this outcome was the large loss of experienced senior and middle level health managers with operational experience. These managers often had a health professional background. It is highly likely that those managers responsible for the decision to cut the maternity beds had much less experience and insight over the risks than those employed by the former Capital & Coast District Health Board before its disestablishment on 1 July 2022. The short-lived but distressing bed-cutting decision demonstrates a failure to recognise where relevant expertise and experience resides. At the point when the idea of cutting maternity beds arose there should have been immediate engagement with O&G specialists and midwives over the implications and risks. Further, having received their advice, they should have heeded it. The final take-home point is the importance of voice in healthcare. I have previously discussed this importance in BusinessDesk (6 September 2022): Healthcare accessibility depends on health professional voice. It was the voice of the midwives and O&G specialists (and their unions, MERAS and Association of Salaried Medical Specialists, plus the O&G professional college) along with good reporting by Radio New Zealand that forced the backdown. Nothing more and nothing less! 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.
RNZ News
6 days ago
- Health
- RNZ News
Health NZ board re-established by government
Health New Zealand commissioner Lester Levy will chair the new governance board for the next year. Photo: RNZ / Nick Monro The government is re-establishing the Health New Zealand governance board, putting current commissioner Lester Levy in charge. The board was axed a year ago, when the government said it had serious concerns about oversight and a budget blow-out. Levy was then brought in to lead the agency, saying his priorities were reducing wait times and improving productivity . Health Minister Simeon Brown said under Levy's leadership as commissioner, Health New Zealand had delivered a strong financial plan, and a clear health delivery plan was now in place. "He is refocusing the organisation on patients and driving progress on the government's health targets, which are seeing waitlists reduced," Brown said. Brown said Levy would chair the new board for a 12 month term to ensure continuity of leadership. He said he would begin a nomination process later this year for a permanent chair to take effect from July next year. Other key appointments announced by the minister: Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
Scoop
6 days ago
- Health
- Scoop
New Governance For Health New Zealand
Minister of Health The Government is today announcing the reestablishment of the Health New Zealand Board, with new appointments to drive its priority of ensuring timely, quality healthcare for all New Zealanders, Health Minister Simeon Brown says. The re-established Health New Zealand Board will take over from the Commissioner and Deputy Commissioners appointed last year to stabilise the organisation and set a clear direction. 'Under Professor Lester Levy's leadership as Commissioner, Health New Zealand has delivered a strong financial plan, and a clear Health Delivery Plan is now in place. He is refocusing the organisation on patients and driving progress on the Government's health targets, which are seeing waitlists reduced,' Mr Brown says. Professor Levy has been appointed Chair of Health New Zealand for a 12-month term to ensure continuity of leadership. His appointment will maintain momentum on the Government's health targets and keep the focus firmly on patients. Mr Brown also announced his intention to begin a nomination process later this year for a permanent Chair to take effect from 1 July 2026. 'I have also appointed an experienced team of Board members who will support Health New Zealand to deliver for patients, including the appointment of Dr Andrew Connolly as Deputy Chair. Dr Connolly is an experienced surgeon and clinical director who has also held numerous appointments across Governments, including Chair of the Medical Council, Crown Monitor, and Commissioner on District Health Boards. 'I am also appointing Hamiora Bowkett as a Crown Observer to keep a close watch on performance and support the Board with independent oversight. This role will focus on supporting the Board's re-establishment and ensuring Health New Zealand delivers on the Government's health targets. Mr Bowkett will advise me directly, with a particular focus on Health New Zealand's financial position and the delivery of health targets.' 'We're also tackling one of the biggest barriers to better care - our ageing health infrastructure - by establishing a dedicated Infrastructure Committee to make sure our Government's significant investment in health infrastructure delivers modern facilities, on time and on budget. 'This is about accountability. Patients care about seeing a doctor sooner, getting their hip surgery faster, being treated in a hospital that works. That's what these governance changes are designed to achieve.' The key appointments include: Professor Lester Levy, currently Commissioner of Health New Zealand and Chair of the Health Research Council, has been appointed Chair of the Health New Zealand Board for a 12-month term. Dr Andrew Connolly, a senior surgeon and clinical leader, is appointed Deputy Chair. Board members include Roger Jarrold, Dr Frances Hughes, Parekawhia McLean, Peter McCardle, and Terry Moore. Hamiora Bowkett is appointed as Crown Observer to support and monitor Health New Zealand. A new Infrastructure Committee, chaired by Dr Margaret Wilsher, will oversee the delivery of critical health projects, supported by experienced members: Mark Binns, James Christmas, Sarah Sinclair, Evan Davies, and Roger Jarrold. 'I want to acknowledge the work of Professor Levy as Commissioner, and thank Deputy Commissioners Roger Jarrold, Ken Whelan, and Kylie Clegg for the rapid progress they have made in refocusing Health New Zealand on patients. "There is still much work to do, and I look forward to working with the Health New Zealand Board to deliver for patients, achieve the Government's health targets, and continue driving progress on the key priorities I announced in March. 'These changes ensure we have the right people in the right roles to get it done.' Appointed members will assume their roles on 23 July 2025, when the Commission ends. Health New Zealand Board appointments Professor Lester Levy CNZM – Chair Professor Lester Levy is the current Commissioner for Health New Zealand and serves as Chair of the Health Research Council. He has chaired multiple District Health Boards and is a Professor of Digital Health Leadership at Auckland University of Technology. Professor Levy has been appointed to a 12 month term. Dr Andrew Connolly MNZM – Deputy Chair Dr Andrew Connolly is a general and colorectal surgeon with a distinguished clinical background and is currently the Chief Medical Officer at Counties Manukau. He is also currently the Chair of the Health Workforce and System Efficiencies Committee, a former Chair of the Medical Council, and former member of the Health Quality & Safety Commission. He has also served as a Deputy Commissioner and Observer for various District Health Boards. Roger Jarrold – Member Roger Jarrold is currently Deputy Commissioner – Finance of Health New Zealand and a Board member of the New Zealand Blood and Organ Service. He has extensive financial experience, having worked in finance in the private and public sectors for over 40 years. Mr Jarrold has been appointed to a 12 month term. Dr Frances Hughes CNZM – Member Dr Frances Hughes is a registered nurse and current member of the boards of the Health Research Council and the Water Services Authority. She has over 30 years of nursing experience and has held senior healthcare positions in several countries, including as Chief Nurse of New Zealand at the Ministry of Health, Chief Nursing and Midwifery Officer at Queensland Health, and Chief Executive Officer at the International Council of Nurses. Parekawhia McLean (Ngāti Maahanga, Waikato, Ngāti Maniapoto) – Member Parekawhia McLean is currently the Chair of the Hauora Māori Advisory Committee, Te Whakakitenga o Waikato (the governance body of Waikato-Tainui), a director of Transpower, and the Chief Executive of the Criminal Cases Review Commission. Parekawhia has extensive governance experience and is a former Chief Executive of Waikato-Tainui. Hon Peter McCardle – Member Peter McCardle has over 30 years of public sector and political experience, with a strong focus on health policy and system performance. He served as a Member of Parliament from 1990 to 1999, including ministerial portfolios. He also served as a member of the Hutt Valley District Health Board and Upper Hutt City Council as Councillor, Deputy Mayor, and Chair of the Council's Audit Committee. Terry Moore – Member Terry Moore is the current Chair of Canopy Healthcare, Deputy Chair of IGENZ - Innovative Genomics, and a Board member of CHT Care Homes. Terry brings significant experience working in both the public and private health sectors, including serving as the CEO of Southern Cross Healthcare between 2007 and 2022. Crown observer Hamiora Bowkett (Te Arawa, Te Rarawa, Ngāti Rangiwewehi) Mr Bowkett has 25 years' experience across the public and private sectors, with expertise in health, infrastructure, and Māori development. He currently leads the Health Assurance Unit, overseeing key Government health priorities, including infrastructure funding, legislative reform, and monitoring of Health New Zealand. In 2019, Mr Bowkett was jointly appointed by Ministers to the Capital & Coast and Hutt Valley District Health Boards. Ministerial Health Infrastructure Committee Dr Margaret Wilsher – Chair Dr Wilsher is a highly experienced respiratory physician and Chief Medical Officer at Health New Zealand - Auckland. She has significant senior governance experience and extensive financial and clinical leadership experience, including serving on the Capital Investment Committee for the Government overseeing health infrastructure investment between 2011 and 2023. Mark Binns Mr Binns is a qualified lawyer and a former partner of Simpson Grierson in Auckland. He was Chief Executive of Meridian Energy from 2012 to 2017, and before that spent 22 years with Fletcher Building, including 15 years as Chief Executive of the Construction and Infrastructure division. James Christmas James Christmas is an Auckland barrister with extensive experience in public law, governance, and Crown entity oversight. He has advised on major policy and infrastructure matters and brings a strong understanding of public sector accountability, financial management, and the legal frameworks that govern infrastructure investment. Sarah Sinclair Sarah Sinclair is a highly regarded construction, infrastructure, and energy specialist with extensive experience acting for both government and private sector clients in large-scale, complex infrastructure projects and public sector reform programmes. Evan Davies Evan Davies has multi-sector knowledge and has held a diverse range of senior leadership roles over the last 30 years. He has recently been appointed as the Crown Manager to the Health New Zealand New Dunedin Hospital Inpatient Building Project. Roger Jarrold (see bio above) The Minister announced his five key health priorities in March at his speech to the BusinessNZ Health Forum. These priorities can be found here: The intention is that the infrastructure committee will transition to become a permanent infrastructure committee of the Health NZ Board once amendments are made to the Healthy Futures Act. All members will transition from the Ministerial Advisory Committee on Health Infrastructure to this new infrastructure committee once it is established.
NZ Herald
16-06-2025
- Health
- NZ Herald
Health NZ told to give private hospitals 10-year outsourcing contracts
RNZ Health NZ has been directed to give private hospitals 10-year outsourcing contracts to perform elective surgeries. Health Minister Simeon Brown made the request in his Letter of Expectations to Health New Zealand's Commissioner Lester Levy, which was sent in March, but
RNZ News
16-06-2025
- Health
- RNZ News
Health NZ told to give private hospitals 10-year outsourcing contracts
Health Minister Simeon Brown says 10-year contracts with private hospitals would "improve the cost effectiveness of delivery". Photo: RNZ / Marika Khabazi Health NZ has been directed to give private hospitals 10-year outsourcing contracts to perform elective surgeries. Health Minister Simeon Brown made the request in his Letter of Expectations to Health New Zealand's Commissioner Lester Levy, which was sent in March, but only publicly released recently. Brown announced last week that nearly 10,000 elective surgeries had been performed, most outsourced to private hospitals, putting Health NZ on track to reach its end-of-June target of more than 10,579 operations. Private hospital outsourcing contracts tended to be short-term in the past, but Health NZ has been negotiating three-year panel agreements with private hospitals that guarantee high volumes of "low complexity" patients. In his letter, Brown has now directed Health NZ to seek even longer-term agreements. "Prioritise medium term (circa 3 years) agreements with private providers prior to moving towards longer term agreements (circa 10 years)," he wrote to Levy. Such deals would "improve the cost effectiveness of delivery" and "provide clear investment signals" to the private sector, Brown said. In a statement, Levy said the delivery of health services had always seen the private sector supplementing public health services. "The move to establish longer-term contracts will allow us to build more capacity in the system, secure competitive pricing for services and meet the needs of our communities." Levy said work was underway with private providers to ensure outsourcing was sustainable for the health system. But Labour's health spokesperson Ayesha Verrall did not support such long outsourcing contracts. "This indicates a direction that private provision will become part of the normal arrangements for elective surgery and in New Zealand, not just a stop-gap to clear backlogs," she told RNZ. The Royal Australasian College of Surgeons said it was "very concerning." "We were sold outsourcing as a short term solution to a backlog, and in that situation it has been moderately successful. "But outsourcing is not a solution to an inadequately funded health system," RACS president Ros Pochin said. Outsourcing electives deprived surgical registrars' of the training they needed, but it was also much more expensive, said Pochin. "There's plenty of studies world-wide showing that private healthcare actually costs more. It's actually much cheaper to appropriate resource hospitals. "I understand that the private hospitals needs certainty in terms of contracts, but why don't we just invest in infrastructure and provide care in the public system where we already have hospitals. The New Zealand Private Surgical Hospitals Association (NZPSHA) was unaware of the minister's plans for decade-long deals, until alerted by RNZ. NZPSHA president Blair Roxborough said they had been asking for longer-term arrangements but had not been given a specific time frame. "I'm not quite sure where 10 years comes from, but obviously with that certainty, that length of agreement, that does allow for better planning, better investment." Any discounts for such long contracts had yet to be discussed but it was "not unreasonable" to expect such deals would provide "certainty on costs," he said. In a statement, Brown said Labour's long wait times for elective surgery were unacceptable. "Patients don't care who is delivering their surgery, they care about getting their hip, knee and cataract operations done. "I make no apology for outsourcing procedures so that we can reduce the wait lists and ensure patients receive the timely, quality care they deserve." Brown said under Labour, the number of people who were waiting more than four months for elective surgeries had grown from 1000 in 2017 to over 28,000 in 2023. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
