By RNZ

The “14 layers of management” at Health NZ Te Whatu Ora criticised by the Government as bureaucratic bloat include the patient, and the nurse or doctor providing care for them.

Prime Minister Christopher Luxon a week ago announced alongside Health Minister Dr Shane Reti the board of the nationwide health would be sacked and replaced by a commissioner, who would be the chairman Lester Levy.

The board had shrunk to two from the usual seven after several members resigned early, or declined to rejoin after the end of their terms.

Luxon and Reti however argued “major challenges” stemming from the merger of DHBs as part of the previous Government’s health reforms had led to overspending of about $130 million a month, with the organisation on track for a $1.4b deficit by the end of the year.

Luxon said the reforms had led to a lack of performance monitoring, limited oversight of financial and non-financial performance and “up to 14 layers of management”.

“Having 14 layers between the CEO and the patient, if you’re a front-line doctor or nurse, what you’re hearing is lots of management mush, but you’re not getting real clarity about what’s being expected of you,” he said.

“We’re not getting the health outcomes against the five targets that we’ve got. We’re not managing the budget within the monthly deficit that’s been run up, and we certainly aren’t getting a clear organisational model when you’ve got 14 layers of management between the CEO and patient, and 2500 extra back-office staff. So those are the three things that we’re focused on fixing.”

Reti, asked about what those 14 layers were, and said the organisational chart he’d seen “is just mind boggling. I could not name the different layers of way finders, pathfinders, boundary spanners - Lord knows what else - from A to B”.

He said he would ask Levy to send the chart, and there should only be six layers of management.

“Six ... because that’s the advice we’ve been getting from experts who are helping us with the change management. An organisation of this size should have roughly six layers between the chief executive and the patient.”

However, the list of layers of management provided by Reti’s office included in the 14 layers not only the chair, the board, the chief executive and their chief of staff, but the patient and the “team member” - doctor or nurse - themselves.

1. Chair and board
2. CE
3. Chief of staff
4. National director hospital and specialist services
5. Regional director hospital and specialist services
6. Group director operations
7. General manager
8. Service manager
9. Manager
10. Assistant manager
11. Team leader
12. Team supervisor
13. Team member
14. Patient

A spokesperson said the list was for a specific team, and due to privacy considerations further information could not be provided at this time.

“In response to some subsequent criticism that patients are not part of the system and shouldn’t be on here, I would reject that. They are absolutely a key part of the system and they deserve their place,” the spokesperson said.

Taking Reti and Luxon’s barometer of layers “between the CEO and the patient”, however, the chart provided only shows 10.

Labour’s Health spokeswoman Ayesha Verrall said it looked like it had been “concocted to try and substantiate what the Prime Minister said last week”.

“If you take that approach, even in the first couple of layers there, there’ll be people that are treating patients. So the team leader for example or shift supervisor is likely to be directly involved in care. So they’ve sort of thrown a whole lot of roles that are frontline into a chart and said there’s a bloated management structure.”

Health NZ commissioner Professor Lester Levy. Photo / Dean Purcell

She said the 2500 “back office” staff the Government claimed had been added since 2018 needed further investigation too.

“It does occur to me that we had increased numbers of frontline staff so we need some increased numbers of managers to support them over that period. And also there were programmes we were running in the health system like Healthy Homes, for example - really important for health, but doesn’t need to be run by nurses or doctors.

“But the big point here is that growth led to a Budget blowout that only hit the books in March of 2024. How on Earth could staffing growth over six years only become apparent in the recent months?”