Lester Levy’s six-month report card

Saturday, 18 January 2025

Make the health system better while saving more than a billion bucks, in the space of a year. No pressure, Professor Lester Levy.

Predicated last July on what Prime Minister Christopher Luxon called Labour’s “botched” health reforms, Commissioner Levy was to create a turnaround plan for Health New Zealand - Te Whatu Ora, an organisation of more than 80,000 people

The move effectively put Levy in the driver’s seat of more than $30 billion a year of taxpayer’s money, an investment that keeps us alive.

Read more: Lester Levy’s first six months - in his own words

The stakes were high - for everyone.

Levy’s appointment began on July 22, meaning on Tuesday, he will be halfway through his $320,000 job.

So how is Lester Levy doing, according to those watching?

Patient advocate

“You can only judge what’s happened and it certainly hasn’t been good,” says Malcolm Mulholland of advocacy group Patient Voice Aotearoa.

“In fact I would say the situation has gotten worse for patients… they're struggling to deal with a health system that just seems to be failing every day.”

Mulholland says it is difficult to understand how things would get better when the clear plan has not been revealed.

“Still, for the life of me, I don't know what his master plan is to turn things around.”

“Just be honest and upfront and be transparent about what the plan is. So that also it can be tracked.

“I think you're going to get a lot more buy-in from the health workforce [to] go, yeah okay, I'll stick this out for three years, five years, so long as I can see improvements being made. But everything today, shows us that the health system is going backwards.”

Senior doctor

A senior clinician The Post spoke to, on the condition of anonymity, says they are learning how to fix essential patient software.

“They used to pay people in IT to support it. Now I do it for free. Money saved!”

Self-troubleshooting wasn’t unusual and a number of doctors have been providing their own IT support before Levy arrived, the doctor says.

But since Levy had arrived: “All I’ve seen is the negatives. Things that functioned have been taken away. Admin support, IT. Inevitably those who remain - clinicians - have to take up the slack,” the senior doctor says.

“There were undoubted inefficiencies but also some blindness to things that worked well. For example, there was no consultation with clinical leads as to the effects of the reported imminent 50% cull in IT staff.

“So I guess so far all I’ve seen is the stick. It would be nice to see the carrot.”

Non-clinical Te Whatu Ora staff

A non-clinical staff member says people in her team at Health NZ are tired, stressed and sick of the restructuring while “it’s being beaten into us that we are massively over budget”.

“We must have been through 30 restructures in the past 18 months.

“People have spent their Christmas worrying about their jobs and scared to buy Christmas presents. It sucks,” says the staff member, whose identity The Post agreed to protect.

She couldn’t understand how Levy was signing off on hundreds of job losses without an operating model.

“Doesn’t this mean the organisation is being set up to fail once again?”

Leaders have stressed many restructures remain proposals and feedback would be taken into account. But “we know that increasing the proposed FTE [full-time equivalent] is not an option” the staffer says.

“Our leaders are making no bones about it. FTE need to be cut.”

The restructuring was also happening before the agency had decided what work to continue and promising to achieve everything ministers asked of them.

“We’re also being told we aren’t going to ‘cut’ work programmes but we will refocus and potentially slow down or defer.

“The proposed number of FTE absolutely cannot maintain current work programmes.”

Hauora Māori leader

In his letter of expectations, Health Minister Shane Reti told Levy to work in close contact with the independent Hauora Māori Advisory Committee to ensure Māori inequities don’t get worse.

The committee’s chairperson, Parekawhia McLean verifies this has been happening, saying she had regular communication with Levy and insight into his thinking process.

This meant the committee had “frank and robust” kōrero with Levy towards the end of last year, McLean says.

“We were very direct with him, as was he with us. We made it very clear that we had expectations around the current funding set aside for hauora Māori health outcomes [that it would be] retained, given the turnaround plan and savings he was looking for. And he gave us that commitment.

“So we call it out when we need to, but we will also [say] ‘have you thought about this?’ Or ‘how about this approach?’”

The committee had also challenged him on why there was no Māori deputy commissioner.

“He saw us as being his independent advisers, holding him and deputy commissioners to account.”

McLean says the committee has been able to do that so far, and has seen Levy’s turnaround plan - which has not been released publicly.

The committee will release a monitoring report soon which measures nine focus areas for Māori health, including protection from communicable diseases through the likes of immunisation, quality of maternity and early years care, access to primary care and cancer care, and work with iwi Māori partnership boards.

Health minister

Reti in August told The Post he would step in if he believed cuts were too close to the bone and, in an interview, says he has done this in the past six months.

“I've had clinicians communicate to me that they may be filling out a theatre list where before that may have been done by someone else… or there are concerns that this particular system has some instability.

“If clinicians flag it with me and there's enough of a voice to say this is not an isolated incident, then I raise it with the commissioner.”

Does he listen? “Yes, he does listen and he does act.”

In a letter dated July 22, Reti laid out the tasks he expected Levy to complete. They included producing a “detailed turnaround plan” by August 2024, with measurable milestones and a plan on how he will achieve “financial breakeven”, which Levy delivered on September 1.

Reti ordered a review of the governance, leadership and operating model, details on how Health NZ would strengthen clinical void in decision making, and a risk and management framework. He confirmed all these things were underway.

Asked about clinicians doing their own IT work, Reti says his Government inherited hundreds of IT vacancies but, “I do understand the need”.

“I have impressed on the commissioner, as we have said, the front line is not to be adversely affected, and particularly where information technology would affect clinical care, the quality of care, or our reporting and management of targets.

“We won't be able to hold ourselves accountable if we can't report on it, because we don't have IT systems that are robust.”

Primary care leader

Waikato-based GP Dr Rawiri Keenan says the cuts so far have “hurt the edges more”.

“That is, they have a disproportionate effect on those already disadvantaged especially for Māori, Pacific and Tangata Whaikaha [disabled people].

“While it may not be directly [Levy] or just the direction of the minister and Te Whatu Ora [or] Ministry of Health, there certainly hasn’t been much, if any, gains for Māori and probably primary care also.”

People are being discharged or sent back to an increasingly overloaded GP workforce - a problem that is not new, but Levy’s moves so far have generally worsened those things, says Keenan, an associate professor of primary care at the University of Waikato.

“It’s often forgotten that when a GP refers to the hospital that’s generally after a long period of work up and already having maximised their care in the community.

“When those people are told to see their GP again it’s shifting the workload but at the cost to the patient and GP clinic.”

Again, this isn’t all Levy’s fault, Keenan says, “but I don’t see a direction currently where those things get better soon”.

Public health professor

Public health professor Lisa Te Morenga is also yet to be convinced Māori won’t be adversely affected.

“These decisions have been made without adequate consultation with Māori.”

“It’s going back to the old days where a paternalistic Government thinks it knows what’s best for Māori.”

Among the job losses proposed - including vacancies - are 50 full-time roles in the Pacific Health team, 125 roles in the Hauora Māori team and 358 roles in the National Public Health Service.

“That’s a lot of jobs lost by Māori, through the cuts to the sector and Māori health. That’s another way of inequities playing out.”

On the positive side, Te Morenga says funding has been promised back to community based organisations, “but I wouldn’t count my chickens till I see that money is actually committed”.

Dr Ayesha Verrall - Labour

Labour’s health spokesperson Dr Ayesha Verrall says the Government is yet to prove the commissioner’s appointment was justified, particularly as Levy has not revealed his strategy.

“How will they make the case that the agency has turned around with no change in governance, no improvements in targets and no turnaround plan?

“This is a massive proportion of government spending being changed by one person, and the public doesn't know how.”

As Reti said himself in July - appointing a commissioner was the strongest intervention he could take as health minister.

Verrall points out in taking these steps, the Government has backed itself into a corner.

“This is the system where the government has the most control, so any problems they now encounter, they own.

“Had they kept a board in place, there would have been a bit more distance between the minister and the consequences of these cuts.

“The Government is able to use the presence of a commissioner to keep changes at Health New Zealand secret in a way that they wouldn't if there was a board publishing minutes and so on. Under cover of all that secrecy, there's large scale redundancies and reorganisation of the sector and cutting of programmes.”

Wait times a focus for 2025 - minister

Reti told The Post he is overall pleased with his commissioner’s progress, but suggests the process has not been without difficulty.

“I can't underestimate and understate the challenges at Health New Zealand that we have walked into,” Reti says.

These challenges persist: Te Whatu Ora’s latest performance metrics, for the three months to September, reveal patient waiting times for ED wait times, cancer treatment and elective treatments remain well below targets, and more people were waiting longer for first specialist assessments than the same time in 2023.

Immunisation coverage for children at eight and 24 months had decreased slightly, as had bowel screening participation, while breast screening and cervical screening rates had improved marginally.

But Reti says the key was the waiting times seemed to have plateaued, which he called a win considering there had been 18,000 more people through emergency departments than the same period in 2023.

“That is not a bad result as we look to stabilise the system. I absolutely get there is more work to do.

“What will we be focusing on this year? It will be timely access - wait times,” Reti says.

Some regions are so stretched they have completely paused routine colonoscopies in recent months, with clinical leaders saying it was due to limited capacity.

Challenged on this, Reti says more investment was on the way to enable a greater level of outsourcing to the private sector.

“How we strike that balance between private and public will become more clear, and it is likely that we'll be using greater outsourcing and private resources and drive into those wait lists… of course there will be funding for that.”

He won’t say whether Levy’s appointment is likely to be extended beyond July, only that it would be a decision for Cabinet closer to the time.

Read how Lester Levy rates his first six months here.