Turbulence at Te Whatu Ora drives spinning narratives

It creates a bit of a “get out of jail” moment for any agreement Ms Willis might have made with Dr Reti

It’s a tricky business working in the health sector. The first trick is figuring out who is in charge.

Just before I took off on a week’s leave, Lester Levy had stepped into the commissioner’s chair at Te Whatu Ora and four regional deputy chief executives had been appointed. Before I returned, Professor Levy had acquired two deputy commissioners: namely, the only remaining board member Roger Jarrold and the former Crown observer Ken Whelan.

Ultimately, the board had become an irrelevancy – the politicians took charge from the moment prime minister Christopher Luxon weighed in with his assessment that “big changes” were needed to the board.

Along with Mr Luxon, lined up behind Professor Levy is finance minister Nicola Willis, health minister Shane Reti and, further in the shadows, cautious about being too close to a slowly unfolding train wreck, the men and women of the ACT Party and New Zealand First.

Unfortunately, I missed this year’s RNZCGP conference, but I gather Dr Reti appeared more relaxed and confident with his GP tribe than he sometimes does with his MP tribe. Perhaps that has something to do with the PM’s proximity.

As Te Whatu Ora continues to struggle on all fronts, many in the primary care sector might find some consolation in primary care’s distance from the central health bureaucracy. But in his speech to delegates at the conference, Dr Reti reminded everyone in the room that they should care about the performance of Te Whatu Ora because the agency’s delivery of the “three key pillars” of the health reforms – hospitals, community care and Māori health – affected everyone in primary care, most specifically through the community care and Māori health appropriations.

Dr Reti acknowledges that in the past, community and primary care funding has been used to subsidise the hospital sector’s deficits. But no longer.

From his speech notes: “The Minister of Finance and I have made it very clear to Health New Zealand that funding should stay in the three pillars to which it is appropriated and should not be used to subsidise other underperforming areas. More specifically, community funding should not be used to subsidise an underperforming secondary sector.”

That sounds clear enough. But those of you who have read the detail in the bodice-ripper that is the Government Policy Statement on Health might recall the following expectation: “Health New Zealand to maintain a focus on achieving financial balance by operating within the financial plan and budget assumptions, including appropriated funding levels, and seek joint Ministers’ (Minister of Health and Minister of Finance) agreement prior to funding costs in Hospital and Specialist Services from underspends in other appropriations.”

Underspend? There’s the catch. If there were to be an underspend in either of these appropriations, surely that would be mismanagement? Nevertheless, it creates a bit of a “get out of jail” moment for any agreement Ms Willis might have made with Dr Reti to keep her hands off the Māori health and community care appropriations.

Ms Willis is the finance minister who paid no heed to the implications for individuals’ health and the sector at large when she took the tax windfall resulting from the repeal of the Smokefree legislation. At the same time, she has been happy with little evidence of health benefit to cut the excise tax on heated tobacco products.

On another front, as minister for social investment, Ms Willis will be battling to get cash-strapped agencies working closer together on behalf of social investment policy. She won’t be looking to fail on that initiative. Money will be found.

Dr Reti’s determination to secure community care and Māori health did little to convince former Te Whatu board member and Wellington specialist GP Jeff Lowe, who told New Zealand Doctor Rata Aotearoa reporter Martin Johnston that, with the appointment of Professor Levy, the agenda at Te Whatu Ora is now about cost savings, and primary care will be under pressure.

Dr Lowe also rejected the narrative that the board lacked financial literacy, pointing instead to the lack of clinical literacy after the board’s demise. He joins other critics in saying the political hyperbole around Te Whatu Ora stems from National’s antipathy to the reforms in general.

One aspect of the reforms that Dr Reti continues to vigorously support is the iwi Māori partnership boards and their key role in his reforms. However, the partnership boards have all the hallmarks that make them ideal targets for ACT and NZ First. There’s a whiff of co-governance, a definite desire for equity and, no doubt, quite a lot of te reo to be heard.

I can’t help but think their continued existence – such as it is now with little to no resourcing – relies on Dr Reti holding onto his portfolio. And that relies on Professor Levy delivering for Mr Luxon and Ms Willis.