Rob Campbell says there is extensive waste in the system. Photo: Te Whatu Ora
Ousted health boss Rob Campbell says plans to trim waste and bureaucracy in Te Whatu Ora will need to be sped up, and it will involve re-allocating or cutting hundreds of jobs.
Campbell was sacked as chair of the health agency earlier this week by the health minister, over concerns he could not be politically neutral.
But he was never going to quietly. His return to a 'private citizen' has not stopped him from speaking out, but it has freed him up to speak out more about the changes he believes the health behemoth urgently needs.
"Dealing with a bureaucratic machine like health, it's been hard to get it moving anything like as quickly as it should be. And that was hard for me to speak out on when I was in the role. Now, I'm not in the role, I can be much more direct about it," he said.
Campbell makes no bones about his frustrations at Te Whatu Ora's slow march to progress.
He said there was extensive waste in the system, some of which had been brought over from the old district health boards (DHBs), but also because of duplication when the DHBs were merged into Te Whatu Ora.
He has suggested some of the duplicated administrative and managerial jobs could be shifted to the front-line, which would address critical shortages, and shift hundreds of millions of dollars away from the overhead towards primary care.
"The system is desperately short of all sorts of resources and people at the front-line. So either people will be able to shift to more useful jobs that are not duplicated jobs, or some people undoubtedly will lose their jobs. And those resources will be applied in the front-line, where they're desperately needed," he said.
"To be critical about what we've achieved so far, we've been far too slow to get to this point, and there's no reason why that cannot be done now, and every reason why it should be."
Unions weigh in on debate
Former Association of Salaried Medical Specialists executive Ian Powell said he agreed with many things Campbell had said, but this was too simplistic and short-sighted.
Administrative and managerial positions were a small proportion of the workforce and were critical, Powell said.
"The more you squeeze those positions, the more you actually increase the pressure on the medical staff, because these things are highly integrated," he said.
"Much of the work done by these hospital administration and managerial staff is linked to hospital services that depend on them doing the sort of background organisational worth and processing, that clinical staff need to do their job."
The wastage was not in the positions, but in the decision-making processes, he said, adding it was top-down and not rooted in engagement.
"The people who know how to improve the health system the best, and to make it more efficient, are the doctors and the nurses and the other professional staff who actually worked in the system. And that's where the savings can be made, is by engaging them more in the decision making."
Campbell said it was hardly a secret amalgamating 20 DHBs into one super-service would result in duplications and subsequent job cuts, and staff would already be aware.
A lifelong union man, he said there had not been nearly enough involvement of staff individually, and of unions and professional organisations.
"I know they feel a bit left out of the process. And so if from the outside, I can give it a bit of a ginger along, I think everyone frankly will welcome that," he said.
The Public Service Association (PSA) agreed workers would need to be fully involved.
"While some redundancies are inevitable as the 20 district health boards are merged into a single national health service, it's way too early to be talking about job losses. We need to be investing in people not removing them," said PSA national secretary Kerry Davies.
"Our members will not stand by as decisions are made and we will be holding Te Whatu Ora to account for the reassurances it has already made."
PM brushes aside Campbell's claims
Prime Minister Chris Hipkins had no interest discussing the substance of Campbell's claims.
"He's entitled to express and say whatever he wants to say now, as a private citizen," Hipkins said.
"His departure from the two roles he has left in the last 48 hours was nothing to do with policy, and everything to do with what's the appropriate level of conduct for someone who's holding a position in which they're expected to be politically impartial."
But National Party health spokesperson Dr Shane Reti said the government needed to be clear on exactly what jobs were at risk, how many, and in what regions.
"It's a very fine line. It takes time, it takes great sensitivity to make those sorts of changes. And you've got to be clear exactly what it is that you're removing," he said.
"For example, if you decide you'll remove payroll and reduce payroll services, then you're going to soon find out in the first payroll round that doesn't go through that you've made a very bad choice."
Campbell said further challenges for his successor to address would include more funding for kaupapa Māori health services, and faster action on pay equity and pay parity.
In a statement, Te Whatu Ora chief executive Margie Apa said "over the course of 2023, we will be working to deliver on the promise of reforms by continuing to unify, simplify, and integrate our team of teams."
But Apa said any proposals were not yet finalised, and they would not be sharing any further information publicly until discussions with staff had started.