New Zealand Nurses Association members protest. Photo / Roz Martin
Opinion:
Former Health NZ chairman Rob Campbell yesterday addressed the New Zealand Nurses Organisation (NZNO) conference. This is what he said:
Kia ora tatou and thank you for the opportunity to be with you today.
I first want to apologise to you and your colleagues throughout our healthcare services.
I took on a role at Te Whatu Ora at which I failed. I should have pushed harder, more openly, and much more assertively for urgent change than I did.
I made the mistake of trying to work within a system which was failing, with structures and practices which, and people who, were failing. That was arrogant and misguided.
When I knew it was not going to work I should have made that very clear. A few ineffective squawks was not enough.
Enough to get me pushed out but not enough. There was too much incompatibility in approach to really effect change.
The system was and remains in a series of crises. It required not an ongoing bureaucratic restructure but a change in leadership and power. It still does.
Some of the crises are financial and funding in origin. Some originate in management and governance. But the main origin is in trust.
As the writer Hunter S. Thompson described his country some time ago at a time of stress: “There is an eerie sense of Panic in the air, a silent Fear and Uncertainty that comes with once-reliable faiths and truths and solid institutions that are no longer safe to believe in”.
To build for Pae Ora, for healthy futures, we must have shared “faiths and truths” and “solid institutions” that are “safe to believe in”. For staff, for patients and whanau. We have a very long way to go.
Pretty early in the piece I had the opportunity to speak with the senior leadership team. I emphasised to them that they must think about their roles as being change agents. They would not “administer” our way to Pae Ora from where we were. Of course, as you know, we are still largely at the start line.
I quoted to the bemused executives the radical doctor and revolutionary Che Guevara stating “at the risk of seeming ridiculous, the true revolutionary is guided by the deepest feelings of love”. The love I urged on them was love for the people working in and those who must be better served by Te Whatu Ora. The practical expression of that love or aroha is to genuinely place all of those people at the centre. Not as a slogan but in practice.
I think I may have been too optimistic about my audience.
As it happens, encouraged by the top leadership they went on to adopt advice from another person with a military but very different background. The text distributed to them was from a General McCrystal fresh from operations in Iraq and Afghanistan, which emphasised building “teams of teams”. By definition, building them from above. It was precisely the wrong model.
One of the reasons it was wrong was that it did not fully integrate the existing union and professional and delivery organisations into the process. It endeavoured to use the management and the structures and processes of the past, adapted to commercial models from business consultants to deliver radical change. This reinforced critical faults in the reform design and timing and implementation.
You see, the system is failing because it is not designed to work. Set aside the various inflexibilities and underfunding of the old system, there was a strong case for reform on equity and efficiency grounds. But the reform chose to ignore the bigger private and not-for-profit health networks and such essential parts as ACC ! It seems incredible but it did. It chose to ignore Whanau Ora and its networks. It swept aside DHB networks (within, between and outside the districts). It centralised much then set up new and imposed devolution structures in the “Localities” and the Iwi Maori Partnership Boards on geography and functionality which had to be built from scratch.
What could go wrong?
Quite a lot as it turned out. But that litany of ongoing, old and new faults is not my focus today.
My message to you is not one of despair but one of hope. It is not a hope that politicians and executives will suddenly improve. The hope that counts and is realistic comes from organisations like yours, from people like you.
I do not need to tell you, though the wider community must be made to understand, that the advances which have recently been made in nurse pay and staffing conditions are far from adequate.
Too little, too late, too narrow. But they have been made and critically the message must get understood, the advances did not come from politicians who may now claim them, not did they come from Manatu Hauora or the leadership of Te Whatu Ora. These people all resisted, evaded and prevaricated about them over years. The pressure, the logic and the execution came from you.
The future advances will come the same way from the same source. Not just for you but for doctors, allied health and others.
You will understand that the day after the election the issues for health services and those who deliver them will be the same. The Minister may be more or less benign. The bureaucrats will bend to whatever wind blows from Molesworth Street. This is not to say that who is elected does not matter (it does for a whole lot of reasons) but the health service issues are still the same. I’m sure that you and your leadership know this and that you are preparing accordingly.
I hope that my advice is not gratuitous but given that I consider you, your union and other kindred people and organisations are the driving force for Pae Ora and its objectives. You always were, though this was not understood. You still are.
It may be that some incoming government will rip up and further disrupt the new system. For all its faults I hope not and do not believe that they will. I do fear for Te Aka Whai Ora if there is a major change. Every effort should be made to ensure it gets a fair go in its mission to substantially improve outcomes for Maori to a point of equality. True equity of course will only come through the exercise of rangatiratanga not a modified Crown agency – a bigger fight still to come whoever wins the election.
The real change in the health services as a whole will not come from above. The various high-level consultative arrangements with health management will, while important to pursue and use, have their limitations. I think that these should be extended and that unions and professional organisations should seek and be given direct decision-making representation on key governance and management bodies.
The artificial distinctions which mirror private commercial structures derive from a neo-liberal fantasyland in which such structures are revered as either natural or superior, neither of which is true. The politicians and executives will duck and dive as they always have around such inclusion and sharing of power. But through “persistent insistence” you will make them change.
I think that the Health Charter - Te Mauri o Rongo – is helpful in this regard. While the process of creating this was imperfect and, while it was somewhat quietly released, the Charter is “a statement of the values, principles and behaviours that we want health workers and organisations to demonstrate”.
It covers both Te Whatu Ora and Manatu Hauora in their conduct as well as all funded organisations. I was a cynic about this and my view has only slightly softened but it does create a level which should be used.
There is a fair bit of standard public service repetition and confusion word soup in the Charter but you have managed to get some very useful hooks into the text that were not in earlier management drafts:
“Workers and their unions are supported to use their voices with confidence, knowing that they will be heard”
“The workforce and their unions are meaningfully involved in decision-making”
“Organisations create and support worker and union participation”
“Workers and their unions are treated fairly and with respect and dignity”
It is well short of the genuine inclusion and power sharing which is needed. After all being “heard” does not get you far, and “meaningfully involved” is either “meaningful” or it is not. But these are hooks which you can, and I am sure will, use to hold political and executive management to account.
In the core union function of collective bargaining there is also a lot of dissonance. Your union is very capable on this, as it has also demonstrated itself to be on pay equity.
There is a legal requirement on Te Whatu Ora as with any employer to bargain in “good faith”. In practice all those involved know that there are very strong guidelines, to put it kindly, in place on the employer side in state-sector bargaining, and that the people you are bargaining with often run out of mandate. There follows a shadow-boxing process which frustrates both sides – often only cut through by threat or realisation of strike action.
Under the sort of stress and complexity that there is with, for example, nursing pay and conditions of work you have to wonder if either efficiency, effectiveness, good faith or “respect and dignity” are currently served. A genuine good faith process would produce an agreed position from meaningful involvement and participation for which funding was sought jointly, doing away with the false or pretend bargaining process. I would not hold my breath for this, so bolstering your collective bargaining skill and strength remains vital.
As you well understand it cannot be left there. In individual workplaces you should be seeking very opportunity to challenge the decision-making process of protective static management which pervades the sector. The Charter requires such challenge.
I think there are similar or more effective opportunities at the locality and Iwi Maori Partnership Board level. These have significant influence at least nominally in the structure. They will be peopled with those who genuinely share your objectives for the system. They are part of the Charter.
I recommend that you are as active as you can be pushing your full range of issues at this level. If I go back to my guerilla warfare inspiration you can build strong support in these parts of the “countryside” of communities to surround the “cities” of national management.
In terms of involvement the Charter is pretty clear. There will be formal opportunities for this at all levels. You have no need, as a union, to allow this to be fobbed off by individual employees being involved in management or governance committees. That is not what the Charter says. For example the Board has a range of topic-based sub-committees.
They already have non-board member participation. There is every reason why a union might seek participation at that level and expect to get it in terms of the Charter.
I do not have anything to offer you in terms of the priorities for your collective agreements, local working conditions, or even sector funding work. You are the experts in that. But I do think that we have reached a point where the biggest issues now are not about structures but rather about how they are implemented.
For all its imperfections the new system is what it is and I know that amongst the many areas of physicals and psychological fatigue is obvious across the sector, “review and restructure” fatigue is present. Funding constraint is real and may even increase. Confidence and trust is low.
This suggests that the great part of action should be around immediately meaningful and practical change. Some big schemes will have to be parked in favour of smaller shifts in practice which make existing things work better.
This is the field where management consultants do not roam and graze; where head office planners and script writers are at a loss; where politicians cannot find grand announcements and photo opportunities; where an extra staff member or a fix to a broken unit is a benefit not a cost; where healthcare happens if and as it can; where people work in real not imaginary teams.
In other words, where you work and where it really matters.
Our system is failing because it has lost sight of this. It will begin to recover when it is shown it again.
You are the ones to do that – it will not happen without you.
Rob Campbell is a professional director and investor. He is chancellor at AUT, chairman of Ara Ake, chairman of NZ Rural Land, an adviser for Dave Letele’s BBM charity. He is also the former chairman of Te Whatu Ora (Health NZ)
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