Is the health system an electoral sword of Damocles for work?

Ian Powell is Executive Director of the Association of Salaried Medical Specialists (ASMS).


The legend of the Sword of Damocles – about the imminent and ever-present peril facing those in positions of power – is relevant for voters in the 2023 general election, as they consider the Labor government’s handling of the healthcare system .

In 2017, the Labor government inherited a health system in crisis, with severe labor shortages.

Although this is a legacy, the government has largely ignored it. Labor shortages now vary between ⅕ to ¼ depending on occupational group. Even before the pandemic, these shortages had serious implications for access to planned surgery and other treatments, overcrowded emergency departments, availability of hospital beds, and compromised ability to diagnose patients in time. clinically appropriate.

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Covid-19 accelerated this, but did not cause it.

The government’s response was obviously pathetic. In 2018, he trumpeted the formation of a committee; in fact, it was a reconstituted committee with less authority than its predecessor.

The government’s only responsiveness was to nurses, who make up the bulk of the DHB workforce. But that was only due to persistent militant industrial action by the nurses, and the dispute remains unresolved.

Public hospitals are heavily dependent on the recruitment of specialist doctors from abroad. Aotearoa New Zealand is one of the OECD countries most dependent on recruitment from abroad.

We are in fierce competition with Australia. But, while the overall salary gap between Australia and New Zealand favors the former by around 20-30%, for specialists the gap is over 60%.

So why the political negligence? The government has made a conscious political call to ignore pressures on the health system and focus instead on restructuring based on the advice of business consultants.

The statutory bodies responsible for delivering community and hospital-based health care to geographically defined populations (DHBs) are to be abolished and replaced on July 1 by a new, additional national monolith: Health New Zealand (HNZ).

Restructuring rarely succeeds in achieving lasting improvements. But the government has instead listened to the external consultants who, unsurprisingly, are the biggest beneficiaries of this restructuring.

Health facilities were not the cause of the workforce crisis, nor is restructuring (or part of) the solution. It’s an ABC of health systems, but one the government has failed to grasp.

Not only has this restructuring distracted the government from addressing the real crisis, but its rushed nature has meant that the new HNZ is ill-equipped to hit the road.

Ian Powell has criticized the government's decision to abolish the DHBs, saying devolving decision-making to bureaucrats in Wellington could have implications for the unique needs of populations - such as those in South Auckland.


Ian Powell has criticized the government’s decision to abolish the DHBs, saying devolving decision-making to bureaucrats in Wellington could have implications for the unique needs of populations – such as those in South Auckland.

HNZ will start with most leaders including interim appointments. These are largely those who currently hold leadership positions in DHB. Ironically, the Minister of Health has scapegoated DHBs for the problems in the healthcare system.

The “tempors” are capable people who will do their best, but they will keep the system going rather than responding to the pressures caused by this labor crisis. This means that there will be a leadership vacuum for some time. Consequently, the labor crisis will worsen.

At the start of 2020, National and Labor were neck and neck in the polls. The National had clawed back a clear Labor lead that had been rightly earned by Prime Minister Jacinda Ardern’s impressive leadership in response to the deadly mosque attacks a year earlier.

The government’s (at the time) impressive and high-profile response to the pandemic led to a complete reversal of the electoral odds seven months later

Labour’s strong polls continued until the end of September, it still handled the pandemic response well.

Subsequently, the wheels crumbled as he resorted to spin rather than scientific evidence to justify his evolution from the laissez-faire response. To top it off, National elected a capable and confident new leader.

Right now, the polls show National a bit ahead. This is largely because Labor has lost its favorable point of difference with National on the response to the pandemic and is not strong on the implementation of various issues including the healthcare system.

Health is an important election issue because of its far-reaching impact on so many New Zealanders. In the 2017 elections, health was detrimental to the national government. Since then, the labor crisis has only gotten worse.

There’s no way ‘Team Interim’ (aka Health NZ) will reverse this crisis, so it’s making a tangible difference in access to healthcare ahead of the next election.

But what made it even worse was the most incompetent decision I’ve seen a government take on health – in the midst of a pandemic, to dismantle the system of supply and delivery of health care in communities and hospitals and replace it with an untested alternative which, for a while at least, will have interim leadership.

At the time of the next election, the government will not be able to blame the labor crisis on the DHBs or the previous government. Labor tends in the polls to be under the sword of Damocles. It will certainly be below at election time.

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