Luxon’s desire for a ‘ruthless focus on execution in health’ sounded brutal but not as brutal as his dismissal of “top quality human being” Dr Reti
My first editorial of the year, and I thought I might be writing about algal blooms in the country’s rivers.
Judging by my inbox when I returned to the office, that was the big health news of the summer – that and the fact that hospital gowns that leave bums exposed make patients feel vulnerable.
But, no, just as I’m contemplating my navel, a Cabinet reshuffle was upon us, and we all knew where that was heading. The demotion of health minister Shane Reti from the portfolio he so longed for was not a huge surprise for sector folk with an eye on politics.
Prime minister Christopher Luxon’s desire for a “ruthless focus on execution in health” sounded brutal but not as brutal as his dismissal of “top quality human being” Dr Reti. He was almost cavalier in overlooking Dr Reti’s mana as the first Māori health minister for nearly 100 years.
While praising Dr Reti as “a good man”, “a class act” and “a team player”, Mr Luxon ultimately implied, being a doctor and all, that Dr Reti would be better suited for his new portfolios – universities, and science, innovation and technology. Newcomer Simeon Brown, on the other hand, “as a father, son and family guy will understand what is needed” to get “regular New Zealanders” timely access to their GP, emergency department, first specialist appointments, elective surgery and cancer drugs.
Dr Reti is a team player, without a doubt.
In his 12-month tenure as holder of the tricky health portfolio, he sucked up the travesty of the Coalition Government’s backflip on smokefree legislation, supported the disbanding of Te Aka Whai Ora, saw off equity-based health programmes, reneged on promises of funding for primary care and has overseen massive, at times seemingly random, cuts to health sector spending.
Alas, for Dr Reti, from day one, the message from the boss, aka finance minister Nicola Willis, was that no matter Dr Reti’s plans for the sector, there was no more money for health aside from fulfilling the election promise of cancer drugs and even that money was tainted – taken in advance from Budget 2025.
In his 12 months, much as he was passionate about his role, Dr Reti could never spell out a vision that people could grab hold of. The one plank he did hold fast to was iwi Māori partnership boards. His demotion now puts the boards at risk. Gone also is any opportunity for him to counter the early suck-it-up elements of coalition government with changes that make a difference.
Stepping up now is Mr Brown, tasked with an “execute and deliver” order from Mr Luxon to “turbocharge the delivery of health outcomes”.
I’m left with the perception that Mr Luxon thinks, simplistically, that if Dr Reti had tried just a little harder, with a bit more executing and delivery, then the health sector would not be the shambles it is now.
It’s ironic, really, because Dr Reti did execute and deliver for the Government. His appointment of commissioner Lester Levy has seen a slash-and-burn culture unleashed at Health New Zealand Te Whatu Ora and ensured that those in the publicly funded sector, aka primary care and community services, have either seen their contracts cancelled, cut or blithely ignored. And that’s set to continue.
Mr Brown has no previous health sector experience, and normally, that might not be a hindrance – many ministers step into areas they know nothing about.
But our health sector is in crisis. While Mr Brown is getting up to speed with the complexities he faces, that crisis will deepen.
He will be wanting to move quickly on Mr Luxon’s imperatives. But he will be no more able to magic up more GPs and funding than Dr Reti was. Some sleights of hand with virtual consults might improve figures, as might sending some elective surgery to the private sector. But both rely on workforce and are unlikely to happen quickly enough for political gain.
Instead, with a steely focus on health targets, there’s a risk Mr Brown will be reduced to ensuring the numbers work, even if the system does not. Gaming targets is nothing new, and with the drive to “execute and deliver”, it could gain new heights.
I wish the best of luck to Mr Brown in rebuilding the morale and trust of the health workforce and in recognising he must engage fully with the primary care sector to achieve truly improved health outcomes.
The health portfolio is tough.
For Dr Reti, the creation of a coalition government and the agreements undertaken made it doubly so. As a “team player”, he will put on a brave face heading into his new portfolios, but I am sad for him. While often reviled as a poisoned chalice, the health portfolio was the job Dr Reti wanted. Maybe it was all about timing – but that’s politics.
