Photo: RNZ / Reece Baker
Labour has seized on the confusion surrounding Health NZ's finances and management structure, saying the minister's claims cannot be trusted.
Health Minister Shane Reti is standing by his claims about the organisation's finances, as well as the claim there are 14 layers of management.
Prime Minister Christopher Luxon and Finance Minister Nicola Willis on Monday had targeted the board and senior leadership at Health NZ, saying they were not financially literate and had failed to ask the right questions.
Luxon also said it was Reti that supplied him with the information claiming the 14 layers of management.
On Tuesday he was clear Reti held responsibility for the portfolio.
"A health minister and Health New Zealand - it's their responsibility to make sure that they're comfortable with the operations and the procedures they've got in place," he said.
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However, he backed Reti's approach.
"The reality is we know there's been poor financial management, poor financial control, and poor visibility of actually what's happening - and that's what we're fixing with the commissioner.
"We've had pretty unreliable financial information since we came to government - and as I said, as you saw yesterday in the letter that Nicola sent in the middle of March ... there was actually forecast for a surplus then it quickly turned into a deficit very very quickly after that."
He said the commissioner - Lester Levy - was "getting the facts in place"
"A lot of that has been getting the cashflow analysis straight, understanding the layers of management, all those things we've been talking about."
The organisation's quarterly report to the end of March showed its operating result for the month was "a $196 million surplus, which was $220 million favourable to budget".
Health NZ chief executive Margie Apa said this did not conflict with the minister's claim of a $130m monthly overspend.
"The information provided by the minister's office is correct, and the quarterly report is also correct," she said. "While we were reporting a surplus in March our financial position had begun to deteriorate and we reported that to the minister. It was highlighted to him at an officials meeting, and a more in-depth meeting was held with him shortly after."
Reti said the quarterly reports became available to him six weeks after they were prepared, and he was getting more up-to-date information from Apa.
"So it's old by the time we get it, it's not as up to date; 23rd of March, I received a letter from CE Margie Apa explaining her concerns about the financial situation. That was the most up-to-date information we received around what the troubles were."
Photo: RNZ / Reece Baker
However, he said he had been getting regular updates on the organisation's finances.
"We were getting monthly reports and quarterly reports from Health New Zealand and the Ministry of Health as the steward of the system was reviewing them as well. And up to March they were predicting they're on task for the savings target," he said.
"The important part here is up to March they were saying they're on track for their savings target, which was 583 million, then on the 23rd of March, I get a letter from the CDC saying that they're not."
He had claimed the previous week that he and finance minister Nicola Willis had to be firm in pushing Health NZ for financial information and board reports.
Hospitals under pressure
He has also been under pressure over staffing at hospitals including Dargaville, where a lack of overnight doctors has meant telehealth is used instead, and at Kenepuru in Porirua where a telehealth company has also been called in to provide support.
"Look, it's a challenge, I worked at Dargaville for nearly six months," Reti said. "I said it was a crisis last year before we came into government, it's certainly a challenging environment, Kenepuru's been something we've been working on for some period of time."
When pushed, he acknowledged it was still a crisis.
"It is still a crisis, we're still working it through. It was then, it is now," he said. "We're not the only place in the world that's struggling with health workforce, I've always said health workforce is our primary issue and it continues to be our primary issue. We just don't have enough people in the right place... particularly in our rural environments."
He said Health NZ was working on the problem.
"We've looked to see how we can staff up the peripheral hospitals, we've also got the rural hospital medical specialist programme which is very strong, it used to be strong in Dargaville as well."
In the meantime, patients with serious health problems who turned up at Dargaville after hours would be stabilised by non-doctor staff before being transferred to Whangārei, he said.
"Bear in mind that Dargaville doesn't have a CCU or an ICU anyway, so that was always going to be the plan. The role of the onsite doctor .... was to stabilise."
Hipkins questions Reti's competence
Labour leader Chris Hipkins raised concerns about Reti's capability in the role.
"The fact that he doesn't seem to know whether he's even been receiving financial reports or not, really starts to question his competence. You would expect a minister with a big portfolio like that to be getting regular financial updates, and to know they've been getting them and to know what's on them. He doesn't seem to be able to provide a consistent answer on any of those issues."
Photo: RNZ / Samuel Rillstone
He said Luxon's recent statements suggested he could not trust what Reti was telling him.
"If indeed Shane Reti told them they were the 14 layers of management ... a claim that he hasn't been able to produce any evidence to back up - then actually the prime minister's right to question him.
"If he was saying 'Oh, well, we first became aware of the financial problems in March' when the paperwork doesn't indicate that was the case, I think the prime minister should be questioning everything Shane Reti is telling him.
"It's not unusual for departmental reports and Treasury reports, for example, to say different things. That's actually when ministers start asking questions, that's when you actually really want to get to the bottom of how is it that these figures are different."
He said the situation at Dargaville was clearly something Reti had known about for some time, and "again, that would suggest that we've got a minister of health is not on top of the portfolio".
"I'd certainly be asking him why he doesn't seem to be able to provide consistent answers about the financial position of health New Zealand, why he doesn't seem to have been getting or asking for the right information, why he seems content to blame everybody else rather than accepting responsibility as a minister, and why he seems to have told the Prime Minister there are 14 layers of management within health NZ when that's clearly not correct."
Layers of management
Reti and Luxon stood by their claim there was 14 layers of management at Health NZ.
"I've seen the list, from chair to patient it's 14 layers ... that's quite normal when you talk from customer to chair or customer to CEO, that's how organisations tend to measure," Luxon said.
When pushed that a patient was clearly not a manager, he pushed back.
"So you're arguing it's maybe 13 not 14, well whoop de doo. It's a big problem, it's a bloated mess ... It's quite common to say 'from CEO to customer', that's how other organisations would look at it as well, what are the layers of management - and you can debate whether it's 12, 13, 14, 15, 20, I don't really care. I've told you it's 14, I've given you the information last week and if you want to debate that that's great but you're missing the point."
Reti said he had received the advice from Health NZ, and went back to double check it.
"And they confirmed that's what it was ... we've provided a list and I believe it was published over the weekend. So I think the important thing here is what did the front line think, do the front line think there are more layers?
He said the important thing was the frontline felt disconnected from management.
"We'll stand behind that table."
Hipkins rubbished their approach.
"I guess if you're looking at at a philosophical level, you know, of course, we all have a responsibility to manage our own health. But the idea that suddenly our patients are a layer of management within the health system is absolutely farcical," he said.
"They're spraying blame everywhere else. And they're not willing to actually front up and accept responsibility for their own actions and their own decisions."