Primary care’s champion on both sides of the table: Cathy O’Malley

How can we regain the sense of collective momentum and a sense of passion and purpose and positivity

It’s hard to see Cathy O’Malley as the retiring type. Sure, she’s cut the formal ties to being a senior government health official, but she retains her enthusiasm for the sector to succeed and seems deeply concerned about where primary care is headed.

She expressed her concerns in a video interview in December, two days before retiring, aged 67, from her role as the Te Whatu Ora Te Waipounamu group manager for systems integration and commissioning.

Asked if she thinks there is a vision for primary care, she is frank: “I think it’s patchy.

“I think it’s hard for people on the ground to have confidence in it because on the one hand it is often stated that primary care, and public health for that matter, are the two foundations of a strong health system. But the investment is not following that.

“The sector has been waiting for a long time post the Sapere report for some kind of resolution of working groups and things that are going on at the moment. It desperately needs that work to come to some fruition and investment to follow the commitment that the Government does state that they have for primary care. But it’s taking a while for sure.”

The Labour Government received the Sapere report in 2022 and it was updated for National Party former health minister Shane Reti last year. It indicates significant increases are needed in capitation funding and suggests pro-equity changes to the demographic weightings of capitation. Dr Reti has said the report needs to be “implemented”, but hasn’t explained clearly what that means, nor when it might happen. Meanwhile the sustainability of general practice has continued to slide.

Ms O’Malley describes the period leading up to her departure – marked for two and a half years by Labour’s and the Coalition’s restructuring and a national budget overrun – as one of huge challenges for the health sector.

Even so, she says primary care is in a better state than 30 years ago, with, for example, the development of multidisciplinary teams, the use of electronic records, virtual care and PHOs.

“What’s on my mind is how can we regain the sense of collective momentum and a sense of passion and purpose and positivity in the system where there’s such a depth of change going on and the need to get on top of the fiscal environment.

“It’s very easy to get on a meeting and then the first 10 minutes of a half-hour meeting chatting about how terrible it is – we haven’t got the staff or we haven’t got the money or we haven’t got the decision-making clarity that we need to make progress.”

But she believes it is possible to get through the negativity and says that what has kept her in the health system for so long is the overwhelming sense of purpose to make the system work well.

“I really believe that we have dedicated, passionate, focused people usually, and at the moment there’s a sense that a lot of that is diverted into a very difficult, negative narrative.”

Everyone needs to own the problems and understand how health can live within the budget.

“But it would far more productive, I think, for that to be in a sense of, ‘So what is the direction of travel, what is the reason we’re all here, and how do we get back to the sense of collective action heading us to a really good outcome’, for our communities more than anything.”

She says it’s not any one person’s responsibility – not chief executive Margie Apa, commissioner Lester Levy or his deputies, nor Dr Reti’s – “I think it has to be everybody’s effort, and certainly the leaders up and down the system have a key role to play in that.”

With a physical education degree, Ms O’Malley was executive director of the Central YMCA for a decade, followed by management consultancy work. She became practice manager of Newtown Medical Centre in Wellington, and in 1995 was appointed chief executive of the Wellington Independent Practitioners Association, formed the same year and a forerunner of Tū Ora Compass Health PHO.

She was also chief executive of the innovative Wellington Maternity Project, Matpro, which negotiated one-of-a-kind state-funded contracts for care shared between GP-obstetricians and midwives.

From 2012 to 2016, she was the Ministry of Health’s deputy directorgeneral sector capability and implementation, after which she held two other senior positions successively for several months before moving to a job in Nelson.

At Nelson Marlborough DHB she was general manager of strategy, primary and community, then moved to her final role, at Te Whatu Ora.

Describing that South Island regional commissioning role, she says, “Commissioning looks after everything pretty much that’s not the hospital… The current structure divides it up by life course: Living Well, Starting Well, Ageing Well, Mentally Well and the rural portfolio. Those managers all report to me. So pretty much all the community-based services contracts across general practice, pharmacy, aged residential care, all the mental health NGOs and oral health.

“The national team sits side by side to the regional team. We don’t report to the national team, but that life course structure is duplicated nationally.”

A veteran of PSAAP (the PHO Services Agreement Amendment Protocol forum), having variously represented PHOs and the government side, she reputedly almost managed to gain access to the talks for a New Zealand Doctor Rata Aotearoa reporter. Her only comment when asked about that is: “Well that’s going back a while.”

Ms O’Malley is a younger sister of Jenny Shipley, the prime minister from 1997 to 1999 and the 1993−1996 health minister, a connection which has resulted in some political shouting. Labour complained in 2000 about tendering of a $1.1 million sexual health contract awarded to the Wellington IPA. Then after a 2001 bipartisan scrap, Labour Government MP Trevor Mallard apologised to the House for false statements about close relatives of Opposition MPs, including Ms O’Malley.

“The auditor-general investigated that,” Ms O’Malley recalls, of the sexual health tendering, “and found there was no evidence, and I can categorically say there was no link between the two of us at the time the contract was let.”

“As a family we are used to dealing with these things…I’ve got a younger sister [Ruth Robson] who is the general manager of the Golden Bay health centre, so technically [via the PHO, I’m] the funder, but those conflicts are declared and I remove myself from those conversations when that funding arrangement is discussed.”

After her father died when she was 12, Ms O’Malley shifted to live with her grandfather in Riwaka near Motueka. She notes the irony of his being a tobacco farmer and she an official who was responsible for Smokefree 2025.

“I used to think he would be rolling in his grave,” she says.

In the year she returned to the region, she told of being diagnosed with Parkinson disease several years earlier. That has progressed, with a tremor that unpredictably comes and goes. Some days she feels pretty normal and others are a challenge physically, although mentally it hasn’t affected her “and hopefully it won’t”.

It is the main reason for choosing now to retire, to allow time to enjoy her four grandchildren.

She also enjoys her garden. “We built a new house when we came to Nelson. We have a new garden, which I spend a lot of time in, and spend time sitting and telling where my husband needs to pull out dandelions. He’s a bit in fear of this retirement gig.

“Whether I can completely turn off my passion for health entirely – I’ve told people I don’t even want to talk about that until the end of summer at least.”

Does that suggest a possible board appointment? “I’ve had a few approaches, but I just said come back and ring me up in April or May and I may or may not be interested.”