GUEST BLOG: Ian Powell – Train wrecks and election outcomes

On 19 June the Sunday Star Times published my column on the relationship between the Labour government’s stewardship of Aotearoa New Zealand’s health system and the outcome of the next general election expected to be around September-October 2023: Is the health system an electoral sword of Damocles for Labour.

Deteriorating workforce crisis is a health system crisis

I began by recognising that the incoming Labour-led government in 2017  inherited from its National-led predecessor a health system in crisis due to severe workforce shortages. Because of its centrality a workforce crisis is by definition a health system crisis.

However, while knowing this to be so, the new government largely ignored the pre-pandemic crisis and the pressures driving it such shortages, increasing acute demand greater than population growth, and worsening illnesses in communities largely due to social determinants of health.

The effect of this deteriorating situation impacted “…severely on access to planned surgery and other treatments, overcrowded emergency departments, availability of hospital beds, and compromised capacity to diagnose patients in a clinically timely manner.”

Covid-19 was not the cause of the workforce crisis; it was an accelerator.

The bigger accelerator

But government inaction was the bigger accelerator. This inaction was due to a mistaken belief that restructuring would somehow fix things despite evidence refuting this view. Government listened to business consultants rather than those with health system expertise.

The political context is that right now National and Labour are neck-and-neck in the opinion polls but the trend favours the former. Health is an important electoral issue because of its extensive impact on most New Zealanders.

Predictably the health system is now on its knees. The government is taking a public hiding with extensive media coverage of the terrible situation affecting patients and health professionals.

But the new Health New Zealand, which takes over the leadership on 1 July will be unable to turn this around in a way that is both substantive and obviously so to voters. To start with its leadership at national and regional levels is largely comprised of interim appointees.

Strategies that need to be developed (and should have been developed years ago) will take time to both develop and implement. It is hard to do this in the leadership vacuum that we now have. Further, a bureaucratically centralist system is more likely not to get it right, at least in a timely manner.

I concluded by stating:

By the time of the next election the government will be in no position to blame the workforce crisis on DHBs or the previous government. Labour is trending in the polls towards being under Damocles’ Sword. It will certainly be under it by the time of the election.

Train wreck?

So does this mean that the health system is heading towards a train wreck? Certainly many with expertise in the health system believe so. But, in the current ‘command-and-control’ environment, they can only talk in corridor and café whispers.

The current situation is well illustrated in a devastating cartoon published in Stuff by Sharon Murdoch lampooning the health minister as ‘Dr Little’.

Sharon Murdoch on Dr Little


One thing is certain. Our already overworked and highly stressed health professionals will continue to provide the best possible care for the ill and very ill who are fortunate enough to access healthcare.

Health professionals can make a bad system work (somewhat) by navigating around obstacles and at the cost of the health. But a crisis of the magnitude that they are currently experiencing is much harder and even more dangerous to their health.

With a leadership vacuum leading to continued neglect of this workforce crisis that is likely to continue for some time, anticipating a train wreck is not an unreasonable call to make. Time will tell. It may come down to a question of not whether there is a train wreck, but the extent of its casualties.

The responsibility buck

It is easy to blame the hapless health minister for this fiasco. Certainly he has not handed the portfolio well. But Little is the ministerial implementer, not decision-maker, of the government’s approach. For decision-maker we have to look at Prime Minister Jacinda Ardern.

Responsibility buck rests with Jacinda Ardern


Prior to becoming prime minister Ardern had minimal understanding of how our health system works. She is accused by some on the political right of being too ideological. I disagree.

Dogmatic is a better descriptor. While she knew little about the health system, she had a predetermined negative view of its leadership and a preference for the advice of business consultants.

It was Ardern who went to EY senior partner Stephen McKernan to head the transition unit. It was Ardern who agreed to him continuing as an EY senior partner while in this role. It was Ardern who located the transition unit in her department with its head reporting directly to her.

And it was ultimately Ardern’s decision to restructure the system for delivering healthcare during a pandemic (difficult to think of what trumps this for sheer madness).

Dogmatism suggests that the Prime Minister is unlikely to see the light over this disaster. But, even if she does and is prepared to admit it, its too late. The damage is done.

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion

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