No holds barred as reviewers portray ministry’s choppy years under Chuah


No holds barred as reviewers portray ministry’s choppy years under Chuah

Big ideas
Reviewers measured how the Ministry of Health has planned and implemented change in the sector, finding multiple failings in leadership and governance in particular

The ministry hasn’t succeeded in its intention to become “client-centric” – it lacks the customer voice

Uncertainty, high staff turnover, negative behaviours, poor relationships, invisible leadership, retreat into “silos” and poorly communicated priorities.

Those problems are described in the State Services Commission’s review of the Ministry of Health, revealing the ministry has a big task ahead to repair damage and become the health system’s clear leader.

The commission’s reviewers were told “universally” that the ministry’s relationships were at an all-time low.

The commission’s latest five-yearly review report was released today, just days after the resignation of chief executive and director-general of health Chai Chuah.

Mr Chuah was first appointed as acting boss in November 2013, becoming permanent 16 months later.

Titled Performance improvement framework review for Ministry of Health, the report says the ministry has not taken a systematic approach to its priorities. This is despite the new direction of the New Zealand Health Strategy (2016) and two years of restructuring under Mr Chuah.

Leadership is invisible in the ministry and across the system, the reviewers find.

They say the executive leadership team (tier 2, below Mr Chuah) spent considerable time “working on itself” and failed to use the managers in the third tier.

“[I]nstead, each ELT member has continued to work through their own lines. Now there is evidence of disengagement at tiers 3 and 4.”

PERFORMANCE IMPROVEMENT FRAMEWORK Review for Manatū Hauora, the Ministry of Health - December 2017
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People have lost faith

Outside the ministry, the report says, the sector was cautiously optimistic last year, but its confidence in the ministry’s capacity to deliver on the strategy has diminished.

Top priorities to advance the strategy must quickly be identified, the report says.

According to a well-placed commentator outside the sector, the ministry never made clear what its role or other players’ roles were in implementing the strategy. “The business cases are not there.”

As the ministry has only limited levers with which to drive the DHBs, collaboration with them is crucial, “and we never saw that”, the commentator says.

“Worse than that, the relationships seem to have deteriorated and, after big mistakes were made [eg, DHB budgets], people have lost faith.”

It’s expected an acting appointee will fill in once Mr Chuah leaves early in February. Although this means another round of temporary role-filling, as happened last year in the executive leadership team restructure, “change is overdue”.

Unsustainable for the future

More broadly, the review team notes the ministry view that the financial model for health services is not sustainable. It has a Better Business Case under way, but reviewers say it’s too soon to predict the outcomes.

Electronic prescribing (five hospitals), patient portals (330 practices) and telehealth initiatives are welcome steps towards efficiency, but are not at sufficient scale or magnitude.

The strategy’s Roadmap of Actions contained key themes, but they have not been progressed.

The intended strategy leadership group, which was to have sector representatives, has not been established.

The reviewers also say underlying tension and apparent lack of trust may be compromising post-earthquake work with Canterbury DHB. Until the ministry and the DHB “can work more constructively together, it is hard to see how performance is likely to improve”.

A brief mention for primary care

The reviewers write: “Utilisation patterns of primary and secondary healthcare have been analysed and compared across different population groups. The insights from this work will inform ongoing policy work for the future direction of primary care.”

Reviewers find the ministry did well in the (now lapsed) immunisation and rheumatic fever Better Public Service targets. The ministry proved “capable” in areas such as regulation, the strategy’s development, and engagement with ministers.

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Source: State Services Commission

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