Damning review of Ministry
By Richard Harman (author)
Just days after its CEO resigned the Ministry of Health is the subject of a damning Government report.
The report has been signed off by the three heavyweights of the public service; the head of the Department of Prime Minister and Cabinet, Andrew Kibblewhite; the State Services’ Commissioner, Peter Hughes and the Secretary of the Treasury, Gabriel Makhlouf.
The report is part of a series of what are called Performance Improvement Framework reviews done periodically for various departments and Ministries.
Most are relatively benign.
But this report finds that the Ministry’s performance is weak in the following areas: Purpose, Vision and Strategy; Leadership and Governance Values; Behaviour and Culture and Management of People Performance.
It also finds that its ability to deliver a fiscally sustainable health system is weak as is its ability to implement the New Zealand Health Strategy.
But the report is particularly damning of the executive leadership team.
“Leadership is invisible in the Ministry and across the system, as the Executive Leadership Team ELT has spent considerable time working on itself,” it said.
The Ministry has set out to implement an internal transformation programme called “Ministry on the Move”.
The report said that it was It was critical that the executives delivered r on business-as-usual while simultaneously transforming the organisation and system to deliver against an ambitious change programme.
That apparently didn’t happen.
“The ELT worked together initially, but is reverting to a group of individuals," said the report.
“ They are technically competent, but do not lead systemically at an enterprise level .”
The Ministry has also developed a “Playbook” to define the values it wants its staff to have.
This appears to have been ignored.
“An issue requiring attention in the Ministry is an apparent tolerance for what is at best described as a lack of respect for colleagues in pockets of the Ministry,” says the review.
“This must be resolved if the Ministry is to achieve its desired culture and state of ‘One Team.'
“For most, the transformation has stalled at restructuring, and without changes in culture, values and behaviours, new equally effective siloes are being formed."
Surprisingly it appears the Ministry does not have a centralised review process.
“The Ministry does not have a centrally agreed programme of review and evaluation of Ministry initiatives or of the initiatives that it funds in the health system.
“ However, many teams commission reviews and evaluations to meet their own programme timetables, though with little apparent consideration of the collective impact on system participants.”
In terms of running a fiscally sustainable health system, progress to improve efficiencies seems slow.
Electronic prescribing is in use in five hospitals with plans for further roll-out in 2017. More than 330 practices have implemented patient portals and over 137,000 New Zealanders have registered to access their health information securely in real time.
Given that there are 20 District Health Boards and that the country has a population of 4.4 million these figures seem minuscule.
And the review is critical of the way the Ministry interacts with its “customers”.
“In order to gain some early momentum the Ministry has partnered with the Social Investment Unit of the Ministry of Social Development to assist with the data analytics components across two areas.
“This is a smart tactic, but it is just a partial solution to the wider need to put the customer at the centre of everything the Ministry and Health and Disability System do.
“ It is unclear at this stage if this important work is adequately resourced and whether everyone in the Ministry understands that the work done in the customer space must be the foundation of all future policy and operations work in the Ministry and across the system.”
Obviously, the new Minister of Health cannot be held reposinbile for the review.
It would not be an exaggeration to say he has inherited a crisis.
“The report echoes the concerns about a lack of Ministry leadership that I have heard time and again in recent years from those working at the frontline of our health system,” he said.
“Many of the issues highlighted in this report were also identified in the 2012 PIF Review.
It’s clear things were going from bad to worse under the previous Government.
“As Health Minister, I welcome this review and the Government will closely consider its findings.
“I will also refer the review to the new Ministerial Advisory Group on the Health System, which was set up to focus on exactly these sorts of issues.”
The former Health Minister Jonathan Coleman told POLITiK that the relationship between the Ministry and the DHBs lay at the heart of its performance.
"They did some good stuff over the last nine years.
"the delivery of services has improved; access to care has increased, and more people are getting access to just about every service and waiting times have decreased."
He said that there was no doubt there were things within the Ministry that needed improving, particularly its relationship with its external partners.
"There is a case for DHB reform, and also there is now a public appetite, and for our first two terms in Government, there wasn't. The DHBs were sacred cows.
I think the public is moving beyond that now."