The commissioner of Health New Zealand-Te Whatu Ora, Dr Lester Levy, has delivered a revealing speech in Auckland, signalling urgent, significant reform of the health system in an effort to haul in record treatment delays.
The man in charge of Health New Zealand has promised frontline clinical positions won’t be cut - but warns an urgent overhaul of the health system will be painful and wide-reaching.
Commissioner of Health NZ, Dr Lester Levy, made the comments in a keynote speech to the nib Health Innovators’ Summit, being held today at the Northern Club in downtown Auckland.
“We have to face some very strong medicine as an organisation. We have to live within our means, and we will,” he said.
“In my humble view, Health New Zealand-Te Whatu Ora has so many priorities it has no priorities at all. We are going to have very clear priorities, we are going to bring focus into the organisation, we are going to bring discipline into the organisation, and we will change whatever needs to be changed.”
There’s never been so much money or staffing put into the health system, he said, but services were not improving, and huge numbers of patients were waiting too long to see a specialist or get their procedure.
“We have got 170,000 people waiting more than four months [for a first specialist appointment]...I believe that the safest wait is the shortest wait, and your disease doesn’t go on pause if you have to wait for a service.”
Bringing such wait lists down wouldn’t be easy, Levy told his audience.
“We will try and move as quickly as we can. You know the cliche, ‘This is not a sprint, it’s a marathon’? Well, for us I’m afraid this is a sprint and not a marathon. We don’t have time.
“John F Kennedy once said, ‘You need to fix a roof while the sun is shining’. Well, the sun has almost gone down for us. We have a narrow window to actually sort this out, in a way that is reasonable, practical and that everyone gets value out of - the patients, the families, the communities, all of the wonderful people who work in our organisations, and the taxpayers of this country.
“The taxpayers of this country should get value for money. This is primarily a taxpayer-funded health system. But there should be value for that. And right at the moment I don’t believe that can be evidenced.”
Levy said Health NZ-Te Whatu Ora would undergo big change, including to its size and structure, with more emphasis put on local and clinical leadership. Some of that change would be painful to those working in the system, he acknowledged.
“And that’s a heartbreaking situation to be in. But I didn’t cause the situation. Unfortunately I need to fix the situation.”
Levy’s speech comes after a Health NZ staff member recently presented information to a meeting that outlined potential and significant cuts to headcount, across the country. That caused Levy and Deputy Commissioners Ken Whelan and Roger Jarrold to yesterday email health workers, saying “what was presented is in direct conflict with our thinking and should be dismissed”.
“The clinical frontline is key to helping ensure faster and easier access to healthcare for people, wherever they live. The clinical frontline will not be cut or reduced, and our plans are to strengthen it.
“We do of course have a serious financial problem and as part of our reset at Health NZ we need to make sure we live within budget, but not at the expense of the clinical frontline.
Sarah Dalton, executive director of the doctors and dentists union the Association of Salaried Medical Specialists (ASMS), said it was great that Levy had committed to keeping staff.
“But we need investment and open discussions, that are clinically led.”
Levy said decision-making needed to be more devolved, with a “hard reset” to move to a more regional and local model, with things like staff recruitment led by the appropriate group of clinical leaders, not someone in Wellington.
Digital innovation was one area the health system had fallen unacceptably behind in, he said, and bravery was needed to avoid being “stuck to sunk costs”.
“The sunk cost fallacy, that just because you have invested a lot of money into something, you should keep investing in it, I just really don’t understand this.”
Levy cited an example he saw while in the United Kingdom, where two hospitals had decided that one would specialise in cardiac surgery, and the other oncology/cancer, instead of the old model of both being done at each hospital.
“They are called legacy systems and legacy investments for a reason. We have to be strong enough, tough enough to actually break some of these umbilical cords that we have, tear down some of these Berlin walls that we have.”
Levy is open to big changes in primary care funding, but said evidence through pilot programmes was needed first.
“If they can do what they can say, and we can prove that, then we will change the funding landscape…if primary care says that we could reduce the admissions of people over 65 into hospital by 50%, if we could prove that - which they believe they can, and actually I believe that they can, too - then we have a reason to change the funding.
“We will have to defund and refund…I don’t worry about winners and losers…I only worry about patients, families and communities…as long as it is legal and ethical I will do whatever I have to do.”
Levy acknowledged opening comments by Rob Hennin, the chief executive of nib New Zealand, the country’s second-largest private health insurer.
“Rob Hennin said when we started that, ‘I hope we can work together’. Well, what I am proposing is a combined operating model, independent of ownership,” Levy said.
“We should have an operating model that we share, some of the services we will fund and provide, some we will fund and not provide, some we will neither fund and not provide.”
Levy finished his speech by revealing a motivation for taking the job was having recently had close family members - his wife, father-in-law, mother and granddaughter - in and out of hospital.
“[My wife] said, ‘After our experience, I will carry you there on my own back. You will have every support that you need. This needs to be fixed,’” Levy told the conference.
“Thank you for listening...I’m not a religious person, but if you are, please pray for me.”
Levy, a former district health board chief, was appointed as commissioner of Health NZ-Te Whatu Ora in July, after the Government sacked the remaining members of the Health NZ board.
He is a qualified medical doctor and is the professor of digital health leadership at the Auckland University of Technology.
He had been appointed to chair the board of Health NZ in May, but after the board was sacked by the government Levy was appointed as sole commissioner for 12 months.
Levy has been tasked with finding $1.4 billion in savings while also improving services and meeting the Government’s national health targets.
Since April, Health NZ has placed significant restrictions on recruitment. While it has denied a hiring freeze on front-line workers, many parts of the sector have said the restrictions were effectively a freeze and were preventing key roles from being filled.
In appointing Levy as commissioner, Health Minister Dr Shane Reti blamed the previous government’s “mismanaged health reforms, which resulted in an overly centralised operating model, limited oversight of financial and non-financial performance, and fragmented administrative data systems which were unable to identify risks until it was too late”.
Labour’s health spokeswoman, Dr Ayesha Verrall, the former Health Minister, has said the previous government was not to blame for Health NZ’s deficits.
Verrall said the Government did not put enough money into health in this year’s Budget. The Government’s $1.4b top-up did not take into account updated figures on demographic changes, she said.
Nicholas Jones is an investigative reporter at the Herald. He was a finalist for Reporter of the Year at the 2024 Voyager Media Awards, and has won numerous national media awards for his reporting and feature writing.