Health NZ commissioner Lester Levy reveals priority to tackle patient waiting times
New health boss Lester Levy has identified shorter wait times for treatment as his top priority – and claims it can be done with existing health funding.
Professor Levy also expressed confidence today in Health NZ chief executive Margie Apa, saying he had been impressed at her willingness to take the organisation in a new direction.
The former district health board chief was appointed commissioner yesterday after the Government sacked the remaining members of the Health NZ board.
He has been tasked with finding $1.4 billion in savings while also improving services and meeting the Government’s national health targets.
That will require the disestablishment of between 2500 to 3000 “back office” roles at Health NZ, which Levy described as “bloated and bureaucratic”. It is not yet clear whether that figure includes 1600 roles already slated for disestablishment as part of the merger of district health boards into a single entity.
Speaking to reporters at North Shore Hospital today, Levy outlined his reasons for taking on the job.
He said New Zealanders should not be waiting so long for essential health services.
“I … want to stress that, from my point of view, the absolute and most urgent priority over the next few years is actually to get waiting times down, because New Zealanders need and deserve a lot better in this regard.”
Levy also said Health NZ could deliver more healthcare with existing resources. He also underlined the importance of a “compassionate” health system, saying at one point that it should be “infused with the milk of human kindness”.
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Who is Lester Levy, the new Health NZ commissioner
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Levy is a qualified medical doctor and is the professor of digital health leadership at the Auckland University of Technology.
He was appointed to chair the board of Health NZ in May this year. Health Minister Dr Shane Reti said at the time that Levy had “extensive experience" in the health sector and would provide strong leadership throughout a period of ongoing change.
Levy’s role chairing the board was to last two years. However yesterday the Government sacked the board – which has been hit by a string of resignations – and appointed Levy as sole commissioner for the next 12 months.
Reti said yesterday that Health NZ was overspending to the tune of $130 million a month. Levy is now required to implement a savings drive of $1.4 billion “to ensure financial balance, and actions to strengthen governance and management”.
Levy has considerable governance experience, having served on more than 25 boards of directors.
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Asked whether he had confidence in Health NZ chief executive Margie Apa, Levy said: "Yes I do."
He said had been impressed by Apa's willingness to adjust to her new direction.
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Lester Levy confirmed he starts as Health NZ's commissioner tomorrow.
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Levy said the issue was not a shortage of money.
"This is a lot of money but there isn't an uplift of performance for that money."
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Responding to a suggestion that nothing had changed around health waiting times in two years, Apa said she did not agree.
"That [wait times] has reduced over the time we have been in place," she said.
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Levy said any cuts that needed to be made would involve wasteful spending and avoidable expenditure - it would not be in the clinical areas.
"We should be creating a much more accessible environment for primary care. We should have more access to diagnostics for primary care.
"You think the Berlin wall went down all those years ago, but we've got lots of Berlin walls to get down," he said.
That was a statement in reference to the "boundaries" between departments or sectors within the entities.
Levy said experimenting would now be part of the new way forward.
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Levy said a focus would be using the same people and same resources in a better way to get better results.
"It does require a different paradigm and a different approach."
Levy said an objective was to have a more transparent relationship with public agencies.
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Apa said a few years ago Health NZ facing a workforce shortage. Over the last six months they had found themselves "over-correcting" much quicker.
Asked about nurses' pay and a suggestion the entity was paying too much, Levy said they paid what nurses deserved.
'We need to have the voice of the clinical people'
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Levy said Health NZ had become an organisation "that is more top-down than bottom-up".
Local knowledge was critical to the organisation.
Levy was asked why change had not already happened when similar statements were made two years ago.
He said he did not want reporters to be asking the same questions in two years' time.
"This is a philosophical thing as well – we need to have the voice of the clinical people much more involved."
Levy said the size of the organisation after the amalgamation was not correct because it was not affordable.
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Apa said the time now was "right for us" to drive change in the regions.
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Health NZ chief executive Margie Apa said the entity now had resources they did not have when they started.
The changes being made would push into regions and how "people resources" were used to make decisions closer to where the people are.
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Levy said the main prize – and the only prize – was to get waiting times down.
Levy said he was "dealing with the cards I have been dealt" and was not interested in going back over what had happened in the past.
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"We want to get everything going, get the waiting times down ... and make everything we do infused with ... human kindness and compassionate."
Levy said he himself had experienced a year of health problems with his family so he knew how complex the system was.
Health NZ 'bloated, bureaucratic'
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The financial problem would be a "challenge" to resolve – but it would be resolved, Levy said.
He described Health New Zealand Te Whatu Ora as quite a "bloated, bureaucratic" organisation.
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"The primary focus is on doing more and doing better for our patients and as part of our move forward we will be moving very quickly to regional revolutions," Levy said.
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Patient outcomes had remained "relatively flat" and the New Zealand taxpayer needed to get more for their dollar, Levy said.
"The primary focus is on doing more and doing better for our patients."
Health NZ needs to be 'compassionate and caring'
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Levy said he would like every single contact people had with Health NZ to be compassionate and caring.
If Health NZ's tanking financial performance continued there would be a big deficit that was not acceptable.
Shorter waits to see a GP
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Levy said the waiting times in several areas, including seeing a GP or waiting to be discharged, needed to be shorter.
New Zealanders needed and deserved that, he said.
"From my point of view the absolute and most urgent priority of the next few years is actually to get waiting times down," said Levy.
Healthcare could be delivered out of the resources we have now.
"Productivity is not an economic or financial construct for us," he said, adding that it was clinical.
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Health NZ’s new commissioner Professor Lester Levy told reporters he took on the role for several reasons, including ensuring Kiwis don't have to wait so long for the health services they deserve.
A critical priority was reducing waiting times, he said.
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Health NZ chief executive Margie Apa says changes are being made to the structure and operations of Health NZ and that work has already begun.
“We will be appointing four establishment regional deputy chief executives empowered with the decision-making authority to organise hospital and specialist services and commissioning teams so that decisions are made closer to the point of care.
“These roles will empower clinical leadership to inform decision-making at regional level.
“It has been a big task to bring so many organisations together as Health NZ, but the job is not finished. We need to continually work on prioritising our resources within our baseline to where it matters most – supporting frontline care whether we provide or fund it.”
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Levy said the Health NZ reset “would ensure we bring our decision-making closer to the communities where care is being provided”.
“We will achieve this by establishing regional leadership that will have the required level of autonomy to arrange their resources to deliver national health targets and health services more broadly for their populations.”
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“We want to deliver the kind of outcomes that New Zealanders expect from the health system and be assured that we are living within the taxpayer resources we are gifted. I know our frontline staff are committed to doing their very best and we must back them to do that,” Levy said.
‘The shortest wait is the safest wait for patients’
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New Health NZ commissioner Lester Levy says Kiwis can expect an “absolute focus on frontline delivery of healthcare” as the organisation undertakes a major reset.
“At the moment, people are having to wait too long for care, and we must do everything within our power to change this. The shortest wait is the safest wait for patients."
Levy said that achieving national health targets for New Zealanders as soon as possible was the priority.
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Earlier today Labour’s health spokeswoman Dr Ayesha Verrall, the former Health Minister, 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.
Health NZ board sacked, commissioner appointed
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Health NZ’s new commissioner Professor Lester Levy and chief executive Margie Apa will answer questions from media today.
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In appointing Levy as commissioner, Health Minister 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, 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.
Health NZ reported a deficit of $1b in its first full year of operation (2022/23) but this was put down to one-off events including the pay equity agreement for nurses and Covid-19 costs.
It was expected to have no deficit in the 2023/24 year and deliver half a billion dollars worth of savings by streamlining systems after the merger of the DHBs.
Reti said he became aware of Health NZ’s deteriorating financial position for the 2023/24 year and beyond in March.
The half-billion dollars in savings were “in doubt” by the middle of the financial year and other solutions needed to be found to bridge the gap, a Cabinet paper released by Reti showed.
Levy said today that Health NZ did not need more money but needed to spend it more wisely: “It can be done but it does require a different paradigm and a different approach.”
Asked what Health NZ was spending $130m above its budget on each month, he said Health NZ may not have been the correct size when it was set up.
Apa said in its early years Health NZ had focused on recruiting nurses, especially from overseas, and had “overcorrected much quick than … expected”. Vacancy rates have been cut from 12% to 6% since 2022.
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.
Levy said he would not make cuts to the clinical workforce in finding the $130m in savings each month.
“We’re not looking to make our savings out of that area but we are looking to get more productivity.”
Levy and Apa promised to “bring decision-making closer to communities” by devolving the provision of services into four regions. Levy rejected the suggestion that this was a reversal of the centralised model set up by the previous government.
While it was described as a “reset” today, the original plan for Health NZ included four geographic regions – Te Waipounamu, Central, Te Manawa Taki and Northern.
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics and social issues.