*This story was first published on August 6, 2021*

Despite billions of dollars going into health, the new minister is stumped by how little has changed, writes political editor Jo Moir

Andrew Little is visibly annoyed by the problems he’s encountered in the health system since taking on the portfolio following last year’s election.

“We’ve put so much extra funding into the system since we’ve been in Government and the same pressures that were evident three years ago are evident now.

“So, what I’m saying is how can we possibly have pumped in billions of extra dollars, and it not appear to have made a difference?’’

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It’s a well-accepted fact the portfolio is seen as a complete hospital pass, and when Newsroom put that to Little, he jokes, “Oh no, there was a long queue for this, Jacinda told me’’.

Chris Hipkins briefly held it last year after David Clark’s fall from grace during Covid-19.

But Hipkins had been clear with the Prime Minister after the election he wanted to keep education and would carry on managing the Covid response providing he didn’t have to retain it as part of the wider health portfolio.

Enter former Labour leader and senior minister, Andrew Little, who after just five months in the role decided it was time to hit the reset button.

In April he announced a seismic overhaul of the sector that would scrap all 20 DHBs replacing them with a new entity (Health NZ), create a new Māori Health Authority and public health unit.

And all of this would be done by the incredibly ambitious deadline of July 1 next year.

“We cannot have another two years, three years, another generation where we try and muck around with the system we have at the moment that disaggregates decision-making.’’ – Andrew Little

Speaking to Little on Thursday, it quickly became clear why he’s moving at such pace.

“Where I think the ministry struggles is being the policy centre and effectively chief co-ordinator of the system, without many levers to do what needs doing.

“DHBs hide behind, ‘We’re a separate entity, we’re our own body and accountable to ourselves’. And that’s what I think has broken down in terms of leadership and management of the system.”

Asked if he’s happy with the level of information he receives from the Ministry of Health to do his job, Little doesn’t mince his words.

“No, no – actually it’s a real struggle to get stuff.’’

The Ministry of Health clearly has its problems, some of which were recently canvassed by Herald columnist Matthew Hooton.

Hooton wrote that departmental chief executives who have worked with the ministry say it is “arrogant and controlling, preoccupied with Wellington politics and incapable of delivering anything operational’’.

Newsroom put this to Little, who quipped, “If they were controlling, they might have controlled a lot more in terms of the DHBs, and they haven’t’’.

A swipe at both the ministry and DHBs in one.

Little says the Government can do better at providing a fairer health system and move away from the current “post-code lottery” nature of it.

He says smaller DHBs don’t have the capability to tackle big infrastructure projects when they’re needed and what the new entity, Health NZ, will mean is that every hospital can look at a patient’s health needs from a national perspective.

For example, if a patient requiring hip surgery can’t get an operation at their local hospital and there’s space for them somewhere else then they’ll be offered the option to go elsewhere.

Little says that will put a stop to people in pain being put on long-term painkillers and stuck at home waiting for a space to open up locally.

“We cannot have another two years, three years, another generation where we try and muck around with the system we have at the moment that disaggregates decision-making.’’

Among many examples of where the system is broken, Little points to two within nursing that he can’t get his head around.

One is having funded over the last three years an additional 3000 full-time nurses to take the pressure off a stretched workforce.

Half of those roles remain vacant, so instead DHBs are paying overtime to already over-worked nurses and paying expensive bills for agency nurses to fill the gaps.

Even when there is funding available, it doesn’t mean the problem goes away.

The same goes for the Care Capacity Demand Management (CCDM) programme, which is designed to achieve safe staffing standards and quality patient care.

The implementation of the programme has been inconsistent across the country.

“It beggars belief that even in the context that we signed up to the safe staffing accord with the nurses’ organisation in 2018 – there was a clear commitment we needed to get on top of this.

“We said ‘Here’s a programme called CCDM, it’s going to take a year of data to implement it’ – and three years on and only half of the DHBs have implemented it.

“The stories I hear from those who are way behind is, they took the view ‘This isn’t for us right now and we’ll do it when we’re ready’,’’ Little said.

“I tend to take the view that people and what they do and the decisions they make is a product of the environment they’re in, and the signals the system gives them.

“At the moment the signals the system gives DHBs is ‘You’re independent and you do what you think is right’.”

Little believes structures dictate people’s behaviour, “and if the behaviours aren’t right then you have to change the structures’’.

Hence the complete overhaul of everything DHBs have become accustomed to.

Some of the fault also lies further up the chain, with those tasked with infrastructure projects.

“Look at the mental health package we did. A lot of it is actually going well, notwithstanding the current popular narrative.

“The one thing I really find extraordinarily frustrating is the commitments we made for rebuilds or significant upgrades of facilities and we’re still trying to get to a point of starting construction.’’

Little says he and Deputy Prime Minister Grant Robertson are now working together to find better and faster ways to make decisions and get work underway on capital projects.

“After having made the decision in 2019 that we’re going to spend $235 million on these five (mental health) facilities – two years on we are still in so-called planning stages and in some cases a site hasn’t even been identified yet as to where a particular facility is going to go.

“It’s just ridiculous,’’ exclaims Little.

As the health reforms start to ramp up, Little will outline the next steps on Friday morning at the annual conference of the College of GPs.

In a few weeks the boards for the interim entities set up as part of the new structure will be announced, and then chief executives will be appointed for each in the weeks after.

Work is underway to get the public health agency established and a health plan drawn up, with the first draft of legislation close to being finished.

Little told Newsroom he expects it to be introduced to the House by the end of next month and passed by the end of April.

In addition, all the funding formulas are being reviewed.

“Patients walking through doors are more complex than they were 10 years ago – they’re older for one thing.

“A 15-minute consultation that is funded for no longer fits, and we’ve got to have a better funding model for at least our more complicated patients,’’ he said.

DHBs also tell Little the population-based funding formulas don’t work or take into account ethnic diversities or the challenges that come with isolated rural healthcare.

Little says getting to July 1 and implementing the reforms and changing who the decision-makers are is one thing.

The bigger challenge is what comes next – the changes in workplace practices and in particular workplace culture and “getting heads thinking as part of a nationwide system’’ and not just one hospital.

Jo Moir is Newsroom's political editor.

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