Matthew Hooton: Disquiet about the Ministry of Health – why its reaching fever-pitch

OPINION:

If you think the Ministry of Health doesn’t have the Covid vaccination programme under control, wait until you hear about mumps. More than a month after I first asked, the ministry has confirmed it doesn’t know how many New Zealanders are vaccinated against any of the diseases on its National Immunisation Schedule.

This includes mumps, but also chickenpox, diphtheria, haemophilus influenzae type b, hepatitis B, human papillomavirus, influenza, measles, pneumococcal disease, polio, rotavirus, rubella, shingles, tetanus and whooping cough.

These aren’t trivial illnesses. The importance and relative ease of keeping them out of New Zealand or under control is why vaccinations against them are offered free of charge to babies, children, adolescents and adults. Taxpayers willingly bear the cost.

Nevertheless, Ashley Bloomfield’s ministry said it does not hold information on the percentage of people in New Zealand who have had the relevant jabs, for 2018 or previous years. It said it doesn’t hold coverage reports for the relevant vaccines and it would not be in the public interest to compile them.

Ministry officials have also confirmed that they don’t know how many cases of each disease there are in New Zealand each year. They were opaque over whether or not they hold information on how many New Zealanders are hospitalised or die with each of the diseases each year, or about their global mortality and morbidity rates. Only after the matter was brought to the attention of the Prime Minister’s Office did health officials rush around and try to supply some of the information.

The ministry suggests the Ombudsman could be asked to review all this, but that is hardly the right authority. Better authorities would be the Auditor-General, the Public Service Commissioner or Parliament’s health select committee.

The ministry says its role is to lead, manage and develop New Zealand’s health and disability system. None of us needs reminding vaccination is key.

Taxpayers also fund the ministry to be the lead adviser to Health Minister Andrew Little and his colleagues on health and disability issues. It says it provides ministers with clear and expert clinical, technical and practical advice, supported by strong, evidence-informed analysis. Little may not agree.

Without basic data on immunisation, how does it monitor, let alone manage and develop the national vaccination programme to ensure it is keeping us safe? How can it advise Little on how effectively and efficiently taxpayers’ funds are being expended for that purpose? How could it ever be able to help Little argue with Finance Minister Grant Robertson for any new cash?

That the ministry doesn’t collect such data makes more explicable the recent problems with vaccination — for measles, influenza and now Covid, including the gross geographic, socioeconomic and ethnic inequalities revealed this week.

But those are not the only questions over the ministry’s performance in recent days. On Wednesday, Chief Ombudsman Peter Boshier reported on an investigation into the ministry’s stewardship of hospital-level secure services for people with intellectual disabilities. He found it had badly failed both disabled people and the Government.

According to Boshier, the ministry had no plan to guide its decisions or develop and deliver services. There was a lack of planning to address the growing demand for hospital-level and community-level services. Its monitoring function was focused on crisis management — is this code for political management? — rather than finding solutions for underperformance.

In particular, Boshier said the ministry did not adequately monitor and review how patients were doing, or “service delivery issues” including with the workforce. It did not develop good quality and timely advice or adequately highlight the urgency of the issues to the minister. Its actions to address capacity issues and related problems were neither timely nor sufficient.

Bloomfield didn’t dispute the report. But he pleaded that, since 2018, his ministry has allocated an additional $1.7 million a year for hospital-based services and $5ma year for community providers, secured five additional beds at Auckland’s Mason Clinic and plans to open a new six-bed secure facility later this year. It seems somewhat inadequate in the context of the damning criticism.

Disquiet in Wellington about the ministry’s performance predates Covid but is reaching fever-pitch.

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. After its failures with measles, influenza, personal protection equipment, the Covid tracing app and saliva testing, they say the Covid vaccination programme should have been led by an agency with operational experience and expertise.

For months, the highest levels of the Beehive have let their profound dissatisfaction with the ministry’s performance be known privately, including around Covid. Beyond the operational failures, they wonder why so much of the communications strategy to ensure compliance with the first lockdown had to be run out of the Beehive.

For his part, Bloomfield speaks admiringly of how helpful the Prime Minister’s Office was with messaging. He overlooks the fact that it’s not the job of political staffers to micromanage supposedly apolitical public health communications. It is his.

Such is the Beehive’s lack of confidence in the ministry that insiders say the Prime Minister now relies for Covid counsel far more on outside experts, including the University of Auckland’s Shaun Hendy, the University of Otago’s Sir David Skegg, former Air New Zealand boss Rob Fyfe and her own Chief Science Adviser Juliet Gerrard.

Insiders say Little — less than a year into the job — has also become frustrated with the challenge ofgetting good data and information from his officials.

The issues around measles, influenza, personal protection equipment, the tracing app, saliva testing and Covid generally are in fact the best advertisement he could want for his proposed health reforms.

Since Helen Clark re-established district health boards, the health system has been stuck in the middle, benefiting from neither the dynamism of the private sector nor the ability toplan and co-ordinate under a centralised system.

Little’splan to establish something like a National Health Service run by the new Health New Zealand and a Māori Health Authority is at least a decision to go in one direction rather than the other.

But his reforms will fail if his new mega-agencies end up staffed by the same Wellington bureaucrats responsible for the status quo. The minister will announce the new agencies’ boards in the next few weeks. The risk is that they will be representative bodies, with all the usual worthies.

What Little needs are people with records of success in running massive organisations, preferably in the health sector and ideally in centralised systems like the one proposed.

We’ll find out next month.

– Matthew Hooton is an Auckland-based public relations consultant.

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