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Health NZ unable to stay within its budget after a period of high inflation and fast population growth

Public Policy / news
Health NZ unable to stay within its budget after a period of high inflation and fast population growth
Health minister Shane Reti answers questions in Parliament
Health minister Shane Reti answers questions in Parliament

Health Minister Shane Reti has replaced Heath NZ–Te Whatu Ora’s board of directors with a commissioner in an effort to halt a projected $1 billion overspend within the agency.

Reti said Health NZ has been exceeding its budget by as much as $130 million a month for the past five months, despite a 6.2% increase in funding included in the May budget.

This overspend would result in an estimated deficit of $1.4 billion by the end of the financial year, if allowed to continue unchecked. 

The Minister blamed the Labour government for the cost overrun, which only started this March, saying it stemmed from too much centralisation in the reformed operating model

Limited oversight of both financial and nonfinancial performance meant directors were unable to identify risks until it was too late, he said. 

Lester Levy, a professor of health at AUT, has been tasked with taking over from the board for the next year as a commissioner. This radical move will give Levy sole control of the agency. 

“This is the strongest ministerial intervention available under the Pae Ora Act and not a decision I have taken lightly, however the magnitude of the issue requires such action,” Reti said. 

Health is the Crown’s second largest area of spending with a near $30 billion budget in the 2024 fiscal year, making it equal to 17.5% of all government spending.  

The Commissioner will have to find $1.4 billion of savings from the agency to keep it within the budget set in May this year. 

Reti has asked for these savings to come from middle management, as much as possible. He believes there should be just six layers of management, instead of 14. 

However, a cabinet paper warned it may not be possible to address all the underlying issues in 12 months and Health NZ could continue to run above its budget in the next financial year. 

Over budget or under funded? 

Labour leader Chris Hipkins and health spokesperson Ayesha Verrall said the agency was only exceeding its budget because it had been underfunded. 

“Let's be clear, this is the government justifying funding cuts because they didn't fund the health system adequately in this year's budget,” Hipkins said. 

Verrall said the Health select committee had been told a 2022 multi-year funding deal given to the sector may not be enough due to higher-than-expected inflation and population growth.

In the year ended March 2024, the inflation rate was 4% and the population had grown by 2.5%. This likely meant the Coalition’s 6.2% increase barely matched increased costs

A cabinet paper said the incoming government was aware of performance issues within Health NZ but the first significant monthly budget overrun was reported in March this year.

“Despite taking immediate steps to constrain areas of overspending and apply cost controls, such as on recruitment, Health NZ’s financial position has continued to deteriorate,” it said. 

Minister Reti denied there was a “hiring freeze” at the agency, despite a reference to constraining recruitment in the paper and reports from many frontline workers. 

Verrall said that was “completely at odds” with what she had been hearing from frontline health workers over the past eight weeks. 

“There are clearly extreme constraints on the amount of frontline staff can be hired,” she said.

Two nurses employed at public hospitals told Interest.co.nz there was a hiring freeze within the agency. One said nurses had been warned jobs would be scarce and that they weren’t allowed to adjust their hours.

Reti said there “hadn’t been a hiring freeze” and hundreds of nurses and doctors had been employed in the past few months. But the cost overruns were due to hiring back-office staff and “outsourced personnel,” he said.

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114 Comments

It’s a tough gig rationing healthcare to sick and dying people 

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16

especially when a growing number dont do a lot for themselves in the first instance.

and its getting harder here to get service even if you are prepared to pay - still get dragged into waiting for a doctor, xray or specialist because of the way the public system is so widely spread.

Last month I visited a GP in Malaysia after injuring my hand in a boat hatch incident. 15 minutes after arriving at GP clinic nurse was dressing wounds, doctor inspected and prescribed antibiotics and half an hour later i left with ointment, painkillers, antiflams, antibiotics and spare dressings all for 150 ringgit (approx $55) and directions to xray clinic if I needed their services. Made NZ A&E look decidedly third world

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11

People go to Thailand for boobs and teeth, probably cheaper for Nz to outsource elective surgery.

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4

This conversation is no longer about cheap. Nothing worthwhile can be made in this country any longer - goods, services, infrastructure, etc.

Maybe we should stop trying to do cool stuff and just focus on our "strength", which is importing cheap unskilled labour by the planeloads, making them work in low-value sectors for crappy pay, charging super-high rents and eventually sell them crappy, overpriced houses.

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10

If we simply take the median monthly wage in Malaysia (5000 ringgit) compared to the median wage in NZ ($5479nzd). It suggests that the equivalent cost in nz would be a minimum of $164.37 (all considering all things being equal). 

Would you be as happy paying $164 in NZ for the same service? (as that is how a local Malaysian would feel, paying what you paid)

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1

Yes without any problem at all - and bear in mind that I probably already pay more than that here given ACC levies -and I am sure the bill to the NZ taxpayer here in NZ would have been greater if I went to the doctor here - and delays worse

Consider the wait times at A& E - there is nothing smart about making people wait - it just adds cost and reflects a deficit in thinking about how to manage resources

Its only a win if some of the "customers" go away (or die waiting) as they all still need to be seen at some point  

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2

But that's not really all things equal - a non-resident in NZ arriving at an accident medical centre is paying $2-300 just to be seen. $90 for the x-ray, and potentially prescription fees on top of that. So ~double for the same service.

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1

As Rob Campbell has said this morning, undoubtedly poor management and leadership, but ALSO totally insufficient funding.

This country needs to get its priorities sorted

And mass immigration does not help.

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19

Immigration policies have for a while been intentionally designed to privatise gains for low-value businesses around the country and socialise the infrastructure/public service costs.

I believe the time for economic reckoning is here with no more of a broader economy remaining for businesses to pass the costs on to.

Either the government of the day makes some cold hard choices to substantially mend our ways going forward (highly unlikely) or we get used to rapidly sliding living standards in this country.

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6

Rob Campbell should know - he has been a part of the problem

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4

Immigration is a very big problem that is completely overpowering us in every sector.  200,000 in one year, almost a city the size of Hamilton.

How do we provide for all these people

Houses

schools

hospitals, health staff and health care

roads

transport

shops

employment

Etc, etc

 

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9

Yup, an issue that no politician genuinely wants to tackle.

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2

Until They relook at the pension, or implement a CGT or land tax as well, this will continue. They need the coffers to pay out the pensions and healthcare irrespective if it means downgrading our living standards in doing so.

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1

What happens when you underfund insourcing and keeping your assets working, and set health targets that are unattainable with the staffing and resource base?

You can choose to pay double to outsource services and pay under urgency when the asset breaks, or you can make the grown-up decision to manage expectations.

Guess which one we've got?

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4

So, costs go up 10%, budget goes up 6%, and there is a 4% overspend? Quick, call in the commissioners!

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23

Add to the costs of +10%, the net population increase (natural + immigration) & the aging population

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0

One more reason to move to Australia 

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8

Reti is right - its a dog of a system overtaken by the cult of managerialism  - keep throwing money at it and more and more managers are hired while service  delivery gets worse and those actually doing the delivery are under appreciated and likely underpaid

Education looks the same as do lots of the monopoly govt agencies.

hard space to recover from

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23

Very wrong on health. The costs are going up a lot as new treatments come online and people survive things they would have never survived even 10 years ago. Go and talk to a doctor or GP.

I don't disagree that there is waste in health organisations (or any other), but the idea that cutting back on x or y will make our health system deliverable within an artificially low budget is deeply flawed.

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22

Grattaway is right. My wife is a nurse.  She has seen no increase in coalface workers but a large increase and creation of managerial roles over recent years. Many, like Associate Charge Nurse Managers, are of a 'working supervisory' nature - but as we all know the 'working supervisor never works. They and all the subsequent growth above them seem to create work for themselves, (and the people below them), just by existing - sort of a self feeding loop.

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18

It is possible for two things to be true at the same time. Health NZ could (a) have recruited millions of dollars more managers (and let's assume that is too many) and (b) be facing hundreds of millions of dollars of cost pressures. My point is simply that tackling (a) barely touches the side of (b).

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10

A health service can take every dollar spent in New Zealand.  And more on top of that.
A limit has to be set and adhered to.
In the end it's a political decision.  Does it deserve some, most, or all of our tax.

Which option do you choose.

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4

I'll get back to you when somebody close to me gets seriously ill.

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1

I last worked in health in Wellington in 2011. Back then it was all about dealing with “long term conditions” and the “aging population”.

Guess what is now costing us billions?

Just like Jfoe said - it’s a case of costs going up 10%, budget going up 6%, and there being a 4% overspend. 

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14

Unfortunately the asset rich aging population aren't asked to pay taxes on the sale of any of their assets like almost everywhere else - so we're low on funding and the funding needs to be paid by younger workers who also have to pay for the ridiculously high rent and house prices which are benefiting the older population's position.

What was that trickle down theory again?

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37

100%
This country is f#%%*^

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14

I'm on track to pay income tax of $3.1m by the age of 65. That doesn't include GST I pay for just about every $ of spend, tax at the fuel pump, tax on interest income etc. tax, tax, tax, tax, but then you also want me to pay tax on the wealth I accumulate to further add to the Governments tax take which seems to disappear into the abyss (or gets given to overpaid consultants, Darleen Tana, bloated bureaucracies up and down the country, 3 waters, cycle bridge, road cones, way over the top traffic management etc.).

On top of that, I can't even rely on most of the public services which these taxes are funding and so have to get private insurance to ensure I don't have to use these public services.  

People are not motivated to roll out of bed every day to pay half their days work in tax - and they never will be, regardless of all the "feels". 

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7

Buy a bike.

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3

Why? Quite fun rally driving my car to avoid pot holes on the way home as apparently not enough money to pay to fix them (but there is enough to employ 5 people to put road cones alerting me to the potholes.

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4

Then cycleways won't piss you off.

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2

Plenty of cycleways...they are called "the road". Existed for quite a long time. 

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0

Yes, but when they became flooded with terrible drivers controlling half a ton of metal, they became quite inhospitable to bikes. I don't mind cycling on most roads, but many will not trust something that isn't separated from traffic, or won't trust their kids on the road. 

I've been cycling around Chch most days for the last decade, plenty of near misses and there would have been multiple accidents if I didn't always assume that drivers can't see and don't think, or don't care. 

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3

"many will not trust something that isn't separated from traffic, or won't trust their kids on the road" - then don't ride a bike. 

If we don't have enough money for health, education etc. then we certainly don't have enough money for cycleways..end of story! 

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0

Still plenty of money available for people over the age of 65, regardless of need.  

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2

I'm all for the introduction of a Tax tab (similar to a bar tab) - and you get to draw down on NZ Super in-line with how much is left in your tax tab. Those who don't have enough in their Tax tab need to keep working beyond 65, until they can no work and then they receive minimum Super. No such thing as a free lunch...unless you live in NZ.   

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0

So while others talk about means testing, or only providing super to those in need as with other benefits payments, you actually think it's a loyalty scheme? As if the best use of government funds is to pay millionaires not to work?

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2

It's quite simple: 

1. You don't get to draw down on Super until 65. 

2. If over your working life you have contributed $3m in tax payments, that appears in your tab 

3. From the tab your burden to health system, and consumption of other public services is deducted (will need to be a complex model). 

4. The net amount is what you get made available to you in Super, spread over 30 years from the point at which you retire.

If your net amount at age 65 is in fact a negative number i.e. you have consumed more than the taxes you have paid - you keep working until you can no longer physically or mentally do so. If your net amount is in positive territory, but not enough to live on - then you qualify for minimum Super payments. 

Your relative "comfort levels" in retirement should reflect the tax contribution you have made to the country.

 

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0

Fully agree. I, like you, will also contribute 3M or more in taxation during my working life, and about half the population will contribute nothing whatsoever. The system will describe would be ideal, however, it would be hugely expensive to administer and would most likely be full of loopholes that people would exploit. That is why for better or for worse we have a one size fits all model.

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0

Hard to tell if satire.  If not, then might be better if you take your wild ideas with you back to the US.  Who cares if you're a paraplegic that nobody will hire, if you haven't paid enough taxes by age 65 then you're not getting the pension.  

USKiwi's dream utopia where the lucky few born with the right skills and opportunity to become net tax contributors (myself included) are guaranteed a winning ticket into retirement, while the losers such as nurses, warehouse workers and delivery drivers are destitute in retirement because they received family tax credits to top up their measly incomes and ensure their landlords can service their huge mortgages.  

While we're at it, let's use that same "tab" to determine who gets access to public health care.  

 

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2

Why are nurses losers ? Why are delivery drivers losers ? I believe Graeme Hart was a delivery driver when he made his first investment. I wouldn't call him a loser.

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0

You failed to read properly - if you lack the ability to physically or mentally work beyond 65 i.e paraplegic, then you get the pension - albeit at the minimum level depending on your “tab”. Also, you are not “born” with skills, you learn them, and if the skills you learn mean you contributed positively to society then go ahead and enjoy your retirement. 

I’m sorry but your utopia is simply not financially viable as we are very quickly finding out (e.g. see headline of this article…). All around the world, the concept of “there is no such thing as a free lunch” is widely accepted, except in NZ apparently where people expect others to fund their retirement for them.

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0

You can rest easy - the budgets for health and education are much larger than the cycleway budget. 

If they don't ride a bike, they drive a car and contribute to traffic, pollution, higher road maintenance, and import petrol from overseas. Probably costs the country more in the long run. 

edit: not to mention our high health spending is partly related to our high levels of obesity and poor fitness...partly caused by people being unwilling to use active transport

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2

You ignore the primary reason most people drive a car...to get to work (so they can pay all those taxes that fund your smooth bicycle paths).   

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0

How did I ignore that? Do you think that no one bikes to work? It's very common here in Christchurch, there are hundreds of bikes in the racks here at the hospital every day. More of my colleagues bike than drive. 

...because we have cycle paths...

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1

People that ride bikes normally know how to ride them and how to behave on the roads. I also rode a bike when I was younger and had no car. I never had any problems whatsoever in Christchurch. My view is that cycle ways make it more dangerous, and you are more likely to get knocked off on a cycle way, particularly when you bring the traffic lights into it. I personally have come very close to knocking off many cyclists because they suddenly appear in the left hand lane at full speed when you are turning left across the cycle lane. It used to be much safer without the cycle lanes, and I am picking that they will eventually be abandoned.

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0

Yes, the roads are fine for us confident cyclists. The cycleways open things up to whole other groups of less confident cyclists like kids and elderly people. 

I am not convinced they make things more dangerous. My route to work and around town is mostly separated, and there are lights to prevent that kind of mix up e.g. along Tuam and St Asaphs, the lights prevent cars from crossing the bike path while the bikes are going. If you're talking about entering driveways etc, this really is a driver awareness problem and you should be checking for cyclists - they are not appearing out of nowhere. Hopefully this will become second nature as cycling becomes more common.

The problem you describe is surely worse when there is no cycle path - the cyclist is often still passing by your left when you turn when they are on the road, and managing this with lights is much more difficult. 

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1

I never found it to be the case. What you where supposed to do, as a cyclist, approaching an intersection, where there is a left turning lane, is drift to the right of the left turning lane if you are going straight ahead so it was clear to motorists that you were not turning. They could then go the left of you, and you go straight ahead. Now, on Selwyn street (in Christchurch) as an example, you have no turning lane any more because it is a cycle lane, and one lane going straight ahead, which also must be used for turning left. So, you have people turning left holding up all the traffic and no one in the cycle lane. So, people get agitated and just turn across the cycle lane without checking to try and relieve the congestion. Cyclists don't care, they just go hurtling up the cycle lane assuming people will just stop. This appears to be quite a common feature for cycle lanes that have been retrofitted to existing roads. They have made it more dangerous.

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1

You can be as confident as ever, but as my driving instructor taught me years back "there's an idiot around every corner". Have been overtaken only to be near run off the road many times before by arrogant drivers, inattentive drivers, have been hospitalised once due to this. I don't have an issue with people driving, but we are humans, and humans have flaws such as inattentiveness, distraction, dissociation, and arrogance on the odd occasion, sadly often when behind the wheel of 1+tons of metal run on explosive fuel. 

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0

According to 2018 census 2.2% of daily commuters used a bicycle. That isn't nearly a big enough number to warrant any form of investment, and so cyclists should use the existing roads so that $ can be spent on much more pressing priorities.  

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1

Here in Chch, we're up to 34% of the population biking at least once a month. A third of people not worth spending some money on? Or the chance of growing that number and taking some stress off the roads and the balance of trade?

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1

Most people in Christchurch using bikes hardly ever use the streets. I use a bike multiple times a month, but not on the roads. Your statistics are mountain bikers.

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1

"About 2.2% of commuters ride to work according to the 2018 census" - this is on the cycling action network website can.org.nz

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0

This is nationwide data. You can see regional data here - central Christchurch is well over double this average, ranging from 4%-20% for central regions.

https://commuter.waka.app/

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0

Nope - not for an activity they undertake 12 times per year. Just ride on the road. 

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1

At least once a month. I'm in that group but I probably ride my bike 360 days a year. 

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0

Good on you - you’ll be confident riding on the road then. 

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0

Yes, I am. I'm not arguing on my behalf here, or on behalf of the other ~5% of the population that are comfortable biking on the road. It's for the 20-30% who want to bike, or want their children to bike, but don't think that the roads are safe. 

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0

Why? - might delay the spend on when we the good old taxpayers has to pay for those of you who think daily exercise is too woke?

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2

"good old taxpayer" = me  

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0

"I'm on track to pay income tax of $3.1m by the age of 65." Congratulations, this countries education, health, and infrastructure has obviously helped you become prosperous.

But if you don't like contributing back to society, there is a sneaky way out. Somalia and Western Sahara currently have no income tax. Go forth and prosper! That would also mean you are not a burden on the rest of NZ in old age too - win - win.

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4

You're missing his point entirely, if he leaves we are all worse off at the margin. NZ has too many takers and not enough contributors, it looks like our economic growth has been propped up by Govt spending and not sustainable economic activity.

If we want to be green and progressive then there are consequences and health care is near the top. We need to invest in education and cut the fat, the fat in this example is lanyard wearing jobsworth middle management. Get rid.

Also, just because cost rise more than income it doesn't mean it's "ok" to plow on. The Board is there to make tough commercial decisions and alert the Minister to additional funding. An effective Board would have started slimming the organisation and finding savings where it could. Reti did well to scak them - they look like jobsworths as well.

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8

It depends how old they are as to whether we are worse off if they leave. Superannuitants are very expensive - one of the biggest of the 'takers' you mentioned, especially when you add in their increasing healthcare needs. If the OP lives to 85, he will have taken over a million dollars of that tax collected straight back again just in super.

It is amazing that the government can just say "there is too much middle management" and some people just believe it. No examples, no proof that there is work that doesn't need doing. No summary of exactly how much can be saved without any changes to outcomes. Just a few reckons thrown about. That seems to be their stock standard excuse for cost cutting government workers. Well, not the important ones like Luxons social media team of six.

I agree they should meet their budgets, I have no insight on how that works at their level. No doubt there are good and bad managers. But I expect the managers National have thrown in are all about cutting costs with little regard for health outcomes. Just like when the last National Government overthrew the elected ECan board.

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4

Is the PV of 20 yrs of pension really $1m? Maybe the FV. 

Either way, he paid in >$3m in direct taxes and probably another $1m in indirect. We should not begrudge him his state super. It's quite clear there has been a big increase of managerial hires, time to slim down.

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2

It costs about $600-700k to buy an inflation-adjusted annuity at 65 that matches Super (noting that we don't have a very competitive market in this area so private costs may be high).

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1

If the statistic is correct that there are in some instances 14 layers of management between frontline staff and the chief executive of these organisations, then that should be all the evidence you need.

Management 101 would quickly teach these people about spans and layers - and no management paper I have ever read has suggested 15 layers is a good idea.  

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3

"Also, just because cost rise more than income it doesn't mean it's "ok" to plow on" - 1000% correct!

If I was to spend company $ outside of my approved annual budget, I would be sacked! How can we have all these layers of management in these public agencies, and yet none of these bright minds can work out how to operate within a budget. 

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0

1. I wasn't educated in this country - maybe that's why we have very different perspectives...

2. Haven't yet been a burden on the health system, and not likely to be so given my health insurance in place & I'm very nervous about public health system (I see we now have a Commissioner trying to clean up the mess...but go ahead explain how everything is in tip top shape). 

3. I live north of Whangarei - not sure I've benefitted from much infrastructure investment. 

4. How does my minimum $3.1m contribution in PAYE by age 65 reconcile to me being a "burden on the rest of NZ in old age". By your logic anyone over 50 should be shipped to Somalia and Western Sahara? 

5. How does my taxes funding Darleen Tana's salary (along with the other items in my list) contribute back to society. 

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1

Classic rightwing play by National/ACT. Underfund something, say its broken and only the private sector can do it properly. Privatise said service to associated cronies.

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0

"but then you also want me to pay tax on the wealth I accumulate" - you can accumulate wealth by doing nothing. If you never paid tax on the wealth you accumulate, then you could get a free ride despite being rich. Not everyone with wealth has obtained it via income. 

Ideally you would pay less income tax if we have a wealth tax. 

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1

Obvious troll is obvious (and a bit simple).

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1

?

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0

Yep, the amount of levels of approval needed for any hiring is mental and it is a shambles. People currently working past their contract dates as it takes too long to to get things renewed, backlogs of police checks, the issues have been created by those at the top. You cant add layers and layers of bureaucracy and expect no slowdown in productivity and efficiency.

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7

Essentially Reti is asking Health NZ to fire 5000 staff paid $200,000 or more. That will cut costs by a billion. Then only $300m of savings to find!

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4

well if that is what a finically affordable health sector has too do then so be it,

unfortunate for those impacted by job losses.

but tax payers can’t keep funding sloppy govt departments with poor financial management 

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5

... start somewhere

“As one example between March 2018 and March 2024, back-office staff numbers which formerly sat at district health board level grew by around 2,500.

“there can be up to 14 layers of management” between the Health NZ’s chief executive and patients."

https://www.nzherald.co.nz/nz/politics/beehives-assumes-close-control-o… 

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7

I'd like to see comparisons with the health departments of Victoria or NSW. We have less population than both of them and they operate in a centralised way from what I can tell. Why can't we just operate like one state in Australia?

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Yes, it is a joke. As part of centralizing things, you decrease staff due to the duplicate roles in the smaller organizations being able to scale out to provide same services to the overall organization. IT is one of these areas. Overall IT should have been slashed by around 80% and the whole organization should have been rationalized and migrated to one system (they were effectively on different installations of the same system anyway). Same will apply to many other departments, which are actually non-health related, such as HR and all the diversity and cultural rubbish should be completely gone. In any case, centralization means a requirement for less staff and more efficiency, not more staff and less efficiency. So, hiring 2500 additional back office staff as part of an efficiency exercise is pathetic and pointless and a total fail. So, this needs to be unwound quickly. Those 2500 have to go, and probably 2500 more have to go as well, which should have been the point of the centralization activity to begin with. It won't be eas, but needs to be done. Otherwise these layer of management and redundant back offer staffers are just chewing through funds that could be better spent on actual HEALTH outcomes.

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2

Whatever flaws there were with centralizing, I think this might have been the last opportunity to get everyone into one system. It would have take a huge amount of effort, but the benefits would be there. At the moment there are more than one Patient Management Systems throughout the hospitals? We have at least 2 interfaces for primary (the last 2 GP practices I've been enrolled to have both switched between Managemyhealth and Myindici), how many imaging service backends? I'm sure there are plenty more. So IT support could have been rationalised to supporting just one of each rather than needing the specialist expertise to support multiple in the same areas. Licensing could be rationalised. Manual transferring of data between systems when patients move.

Anyway........

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Exactly. There are so many things that could be rationalized as a result of centralization. The fact that costs and people actually increased as a result of an efficiency drive is an excellent example of total incompetence. These people have increased costs, decreased services and wasted billions. Unforgivable really. It is not really surprising, in fact it was fully expected. 

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1

Realistically, how can a fully-functioning public health system "survive" when too many of us probably live too long - meaning a greater chance of dying from some expensive-to-treat illness as opposed to a winter flu or whatever, and at the same time too many of us are in appalling condition health-wise (some of it self-inflicted, albeit due to complex factors). 

Correct me if I'm wrong, but I recall seeing some headline that within the next 20 years all of the public health system budget will be chewed up treating type 2 diabetes, for example. 

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That would be this one: https://www.otago.ac.nz/diabetes/research-at-edgar-diabetes-and-obesity-research/diabetes/type-2-diabetes#:~:text=EDOR%20researchers%20are%20working%20on,over%20the%20next%20twenty%20years.

"In 2021 EDOR contributed to a report into the scale and cost of type 2 diabetes.  The report found that nearly 5% of New Zealanders have type 2 diabetes and this is forecast to increase by 70-90% over the next twenty years. The current annual cost of type 2 diabetes in New Zealand is $2.1 billion, which is 0.67% of our country's GDP."

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Can we not have compulsory insurance phased in? 

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Don't disagree with the concept, but presumably we would bump up into the same issues as any time compulsory superannuation savings is mooted ... that it can't be done due to reasons of inequality, as there would be a disproportionate impact on the incomes of the less fortunate.

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In Australia the tax system pushes you into getting insurance as you earn more (the medicare levy becomes higher than the insurance premiums), which frees up the public system for those that can't afford insurance.

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Does it work differently from the way health insurance works here?

My understanding is that private healthcare doesn't necessarily alleviate demand on the public system on a "1 for 1" basis as many of the specialists work in both the public and private sector and prefer private work as it results in more $$$.

E.g. the specialist I recently saw (funded via insurance) also does public work, but whereas I saw him within a fortnight of going to my GP with a specific symptom, I would be waiting months - if I ever got seen - on the public system.

In other words, would effectively mandating insurance (which I am not opposed to) simply mean shifting demand around rather than improving capacity? 

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I'm not fully sure. They have companies like Ramsay healthcare with 70 locations for private care but not sure if the doctors work in both. Certainly there's more money going into the system with more people having private cover. 

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That's the case in my specialty. The majority of our Doctors also pick up a day or two in private practice. Doctor availability is our current bottleneck, meaning we are outsourcing treatments to manage the waiting lists...to the private practice. 

I don't know how you stop that doom loop, but to be fair we have a serious equipment bottleneck waiting just beyond the Doctor bottleneck, which no government seems to be willing to fund. Virtually all new equipment in my area in the last decade has been private, which guarantees more outsourcing at great cost as need grows. 

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Can be long waiting lists to see a private specialist, around 6 months or never for psychiatry, dermatology, neurology despite the high prices, and months for orthopaedics.

We are running out of docs at any price, as the hard working boomer docs retire get sick or die.

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Your last sentence strikes at the heart of the issue.

We just don't have enough medical staff.

We should be looking to pay whatever it costs to bring already-qualified specialists, nurses etc into the country (i.e. running an actual skilled immigration program) to address short-term demand. 1 doctor is worth 1000 takeaway chefs, if not more.

Then we need to be projecting out future demand, and looking to offer no cost pathways to young Kiwis going through school/uni to train in these critical fields and retain them here. 

Simply requiring insurance for higher income earners may even worsen the problem for those unable to afford insurance/private if all the current specialists shift to doing even more private work (I know a few through work in one specialist surgical field, and they typically only do public work if/when they have to, as the rewards come from the private work)

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Correct on the availability front. Some specialists operate only private but I'd wager most do a blend of public and private, and factor in that part of that private is ACC consults, surgeries etc. My wife used to do scheduling for some of them and would have available slots for surgeries or consults always kept available in blocks that could be filled as necessary, with private getting the soonest of the block, then ACC, then public, and then of course the priority of each was relative to how the specialists themselves triaged the referrals.

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We may not have a 3rd world health system but we are certainly trying hard to achieve one....or worse, the US model.

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Reti is tasked to cut and Levy will do exactly that with his past history of management.

There is never enough money for health. It impacts those with less money most.

Levy's stated aim is to giving more decision making power to the frontline. Those rationing decisions are moral type of who deserves it or not.

"This Is Going To Hurt" by Adam Kay is both a film and good read about the failing NHS in Britain and the hopelessness of the task for frontline doctors.

It's a problem everywhere and there's no real answer. Born to die. Suffering not so welcome.

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At least this government acknowledges there's a problem unlike a Labour government would just keep throwing more money at it while hiring more consultants.

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"That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital" - Noam Chomsky

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We hardly through any money at it.

We spend USD$3500 per person on healthcare. In the USA it is $13,500. Are we overspending?

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My understanding was that there was alot of duplication because of the amalgamation , and labour was already reducing these roles.

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He believes there should be just six layers of management, instead of 14. 

what?!

 

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I work in an organisation with 6,000 employees. We have 6 layers between a brand new starter and the CEO. Even that feels bloated at times....

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the layers of management in a orgnization is just like layers of fat in human body, we need them, but too many of them just make it too fat to function. 

Higher for doctors and nurses, fire those bureaucrats! 

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Well, so far the government has apparently made a 4% cut of the health system budget, on an inflation adjusted per capita basis. So we are likely getting less of both.

But let's keep on talking about 130 million a month overspend and the mythical 14 layers of bureaucracy, because that's what the government wants us to focus on while they defund the health system.

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I think that fact that the health system was butchered by the previous government is not in dispute. Everybody accepts that targets were being met, prior to them bring scaped (this happened and is a fact), and delivery slowly got worse and worse as more money got put in (this is also a fact). The DHBs were then merged, which has been a total disaster (also a fact), and now were are at the point where delivery is the worst it has ever been (in my lifetime), and it is all over the media and can be gleaned from anyone you talk to who as experienced the system. So regardless of whether the layers of management are 7 or 14 or 21 who cares, there is a massive problem here to sort out, and it needs to be done. I say good on them for having the balls to come out and openly say it rather than hide behind covid or a bad flu season for their total failure like the last crowd did.

 

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I use to run the NZ manufacturing supply  chain operations division of a multinational operating in 100 countries, there were 3 report line people between myself and the global boardroom in London (Oz local, Singapore regional & UK global). I had a single line structure between myself and the factory floor.

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How many lives did you save?

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I think the point is that the process was run efficiently (and internationally) and did not require 14 layers of management to get anything done.

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I have noticed that nobody is outlining the layers of management. It is just a talking point taken at face value at this stage.

The health organisation must be a very large and diverse one. What particular hirearchy has 14 layers in it? Can we see the layers explained?

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No , you can't because its BS.

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How do the 14 managers who sit between the nurse drawing blood and the Chief Executive save lives?  

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They don't...the most probably cost lives, because they exist to pass bits of paper between each other, tick boxes and attend meetings, generally delay things (which leads directly to bad outcomes and some times death) and often lose said pieces of paper and email trials and cause a variety of different issues leading to generally poor outcomes. 

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Timely reminder that a country has to work out how it wants to use its resources (and how controlling it wants to be). Currently, we have about 280,000 working in healthcare and social assistance. If we want stronger, better-staffed, more responsive, modern health services then we almost certainly need to increase those numbers to something like 320,000 (and, yes, sort out the management layers and structures etc).

To achieve that kind of shift, we would need to move some people from other sectors. So, how do we do that? The simplest solution is to use taxes to reduce our consumption of discretionary things, and for Govt to then spend more on healthcare. Thus, over time, you might reduce retail and hospo staff from 380,000 to 340,000 so that you have more nurses and care workers being paid a decent wage, and less folk selling us crap we don't need in Harvey Norman. 

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Somehow i cant see this govt spending more on healthcare when they can’t see a ROI 😂 i’d be more in lined to think they see spending on keeping people alive costing even more by doing so, thus being a compounding cost if they dint get it back in taxed income. Raw i know but disclaimer: this is an objective emotionless reckon’ 

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"The simplest solution is to use taxes to reduce our consumption of discretionary things" - this statement should scare every Kiwi up and down the country.

So we should all go to work, work hard, but DO NOT HAVE FUN (discretionary), so that we can all donate more money to central government to spend on our behalf.  

Here's a better idea for all those with your mindset, why don't you collectively all scramble to the moral high-ground and donate 100% of your salary to the IRD. 

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You obviously didn't live in NZ during the 1950s/60s. Mind you much of the US wasn't very different. A cursory read - in your case - of Robert Putnam's 'Bowling Alone' - the collapse a revival of  American community will probably have you wishing you stayed there. "Ask not what my country can do for me but what can I do for my country", JFK

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Based on the publically available information this is constructed to appear like it is losing money. It is dancing close to being a lie. 

Reti said Health NZ has been exceeding its budget by as much as $130 million a month for the past five months, despite a 6.2% increase in funding included in the May budget.

up to end of March the organisation was in surplus. There has been no public release of financial information for the last quarter, so we are reliant on this hot mess. 

Also, the "6.2% "increase in the May budget is effective from 1st July. ie the current month. 

there has been no release of the statement of performance expectations which is what the current year should be compared to.  

 

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We spend USD$3500 per person on healthcare. In the USA it is $13,500. Are we overspending?

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