Health ministry failing to measure up - watchdog

The Performance Infrastructure Framework review gave the ministry a "weak" rating for its financial sustainability, and its overall governance.

A damning new report card into the performance of the Health Ministry has found the agency wanting across a number of areas, including financial sustainability, behaviour and culture, and the management of its people.

The high level performance review, led by Dame Paula Rebstock on behalf of the State Services Commission, painted a picture of a ministry that was striving to reduce health inequities but was hamstrung by poor relationships and funding models across a highly devolved system.

The release of the report comes days after director-general of health Chai Chuah announced his resignation, halfway through a five-year term.

The Performance Infrastructure Framework review, or PIF, gave the ministry a ‘‘weak’’ rating for its financial sustainability, and its overall governance.

It was also weak on ‘‘values, behaviour and culture’’. The ministry scored well on ‘‘vision’’ but it needed to ‘‘shift from aspirational statements to bringing the vision, purpose and strategy to life’’.

‘‘Significant resources’’ needed to be committed to delivering on the health strategy, and that would require ‘‘re-prioritisation and decisions to stop some things’’.

And the executive leadership team itself, under Chuah, while it ‘‘worked together initially’’, it had reverted to a ‘‘group of individuals’’.

‘‘They are technically competent but do not lead in a systemic way at an enterprise level.’’

Vote Health was a significant component of government expenditure and had grown both in real terms,and on a per person basis over many decades, the reviewers found. But the rate of growth had slowed since 2010.

The ministry itself identified that the current model for delivery of health services was not fiscally sustainable.

Alongside that, the review noted district health boards had ‘‘increasingly struggled to deliver contracted services within budget, with a number of DHBs reporting operating deficits reflecting ongoing financial pressures within the health system’’.

The ministry had also failed to adequately begin the implementation of the new 10-year health strategy.

‘‘It could track very effectively where there were issues and put very effective mechanisms in place to transfer lessons learnt from high-performing DHBs to ones that were struggling to achieve the target.’’

The ministry’s relationship with the Canterbury DHB got special mention. It had been ‘‘challenging for a number of years’’, the report stated.

‘‘The underlying tension in the relationship and apparent lack of trust may be compromising potential outcomes.

‘‘Until both the ministry and CDHB can work more constructively together, it is hard to see how performance is likely to improve.’’

The report strongly emphasised the need for a social investment approach to be applied to the health system. It was currently working to apply the flagship approach of the last Government in two areas, one of which was mental health.

But the State Services Commission review urged the ministry to apply the approach to all areas of the health and disability system.

‘‘This model will allow investment returns across the health and disability system to be compared and understood in order to inform trade-offs and future investment decisions,’’ the report said.

‘‘While the health targets have enabled greater public scrutiny of DHB-funded services, they give little insight into actual health outcomes and whether each DHB is addressing the most challenging health issues in its community and is meeting the needs of its customers.’’

But there were positives. In implementing the public service targets, particularly related to improving immunisations rates and addressing issues like rheumatic fever, the ministry’s performance was ‘‘strong’’.