Dunedin Hospital - A Mislabelled Failure

Why There's Enough Blame To Go Around For Everyone

I was once a true believer in the virtue of public service, in the good intentions of the many hard working people who had dedicated themselves to making New Zealand a better place.

Then I worked at the Ministry Of Health [MoH], and they killed that part of me.

For every one hard working public servant in that Ministry at that time, there were two more living out some Game Of Thrones/House Of Cards fantasy - people trying to tear down internal rivals or prove their fealty to some higher up by doing what they were ordered regardless of what would be better for the public.

For my sins, it was my job to help the most senior of these people to get away with this state of being, while also keeping as much peace as I could between the two nonviolently warring factions.

I worked in District Health Board [DHB] performance, health workforce planning, large scale capital investments, and complex contracted services, but eighty percent of my time was spent firefighting DHB mistakes.

The focus areas given to me were the three D's: deaths (avoidable public ones), debts (ballooning ones), and dumbasses (senior leaders of a handful of internal departments and two DHBs in particular, who ran services that habitually underperformed, or created hostile work environments, or a dozen other lousy things).

Every day I would awake to a new, entirely avoidable horror.

My role in our public health system was to downplay avoidable deaths in care, minimise perfectly valid lawsuits (including one my employer had already lost in multiple courts but refused to settle, hoping instead that the struggling family would just run out of money or die of old age) and keep the petty disputes that were getting in the way of important decision making out of the media.

None of this was in the JD, but it was the job as it was explained to me directly by my bosses, their bosses, and their bosses bosses.

Fortunately for the nation, these people were quarantined to offices on Molesworth St and The Terrace, so they couldn't directly cause deaths or serious injuries.

As it was clear to me, the effects of their poor decision making (important infrastructure spending kicked down the road) take years (sometimes decades) to appear, and my job was to fight the fires visible currently.

Any fires building up under the surface would be my successor's problem.

It has been over a decade since this first stint as a ‘fixer’ for our broken public health system, and now those ‘rubes’ in the public and media are waking up to the consequences of what was going on… and they're blaming the wrong people.

In that aforementioned decade plus, every person who sat with me around a board table for the Capital Investment Committee [CIC] during one of our several 'this time we'll really do something about the Dunedin Hospital' meetings are all gone.

They either left for highly paid consulting roles, mostly overseas, or just into an extraordinarily comfortable retirement they funded by not advocating for anything that might cost money or require any kind of accountability during their tenure.

I was aghast at the reticence these committee members had around pointing out the obvious to Ministers, that being their jobs and all, but after seeing their post-CIC careers it makes more sense. These were people surrounded by chaos and desperately looking for an exit strategy, they had no fight left in them.

Local Dunedinians (?) should have felt more loyalty to their province, but the then-Southern DHB was the worst basket case health board in our nation's history and its constantly woeful leadership was the reason why.

SDHB took the petty internal warring to another level. I have been advised by council not to disclose the details of these disputes, but Southern have avoided all accountability for using the new hospital as a political football for two decades and never actually committing to a solution that might cost money or require any kind of immediate accountability.

A former staffer for Health Minister Andrew Little told me once: "if we had to rely on Auckland DHBs only when making our case for amalgamation we would have failed, Southern DHB inglorious history really sold the case.”

While I don't support amalgamation any more, I spent more time putting out fires in the Southern region than any other.

They have avoided public ridicule because no one really understands how public health infrastructure is managed, and no one really wants to, so they could blame the central government and the media wouldn't question this framing.

This has a knock-on effect of making leaders more emboldened to do nothing. From a game theory lens, it makes doing nothing the only logical choice.

For over twenty years, the majority of our most senior public health leaders have sought to be neither seen nor heard - just paid.

The big boss of MoH during the time I am writing about, our then-Director General of Health, Chai Chuah - a man whose financial scandals (https://www.1news.co.nz/2017/12/04/embattled-director-general-of-health-quits-role-after-budget-blunder-scandal/) and overall poor leadership cost him a role no one else wanted - appears to have disappeared off the earth and the internet since his contentious ouster in 2017.

Even when it was widely known that Chuah wasn't up to the job and didn't have the support of either the Minister or the then-State Service Commissioner Peter Hughes, and even after the role was (allegedly) offered to at least a half dozen other candidates, no one wanted the top unelected job in our public health system.

We're talking about a role paying in the 400-600k a year region, a pretty damn good region to find oneself in, so why would no one want the job?

Because no one wanted to inherit responsibility for decades of delayed expenditure, multiple half completed restructurings, and a pretty toxic workplace where personal preservation was valued above all else.

Chuah was eventually replaced by Ashley Bloomfield, who was no one's first choice at the time but who was then known for running quite ‘lean’ organisations - which is beltway slang for he was okay cutting services and didn't ask for extra funding too often - so he appealed to a public service scared of its own shadow.

After gaining a knighthood, and spending an inordinate amount of money on consultants (e.g. people who don't engage in internal politics, because their loyalty is to their Big 5 consulting firm, and not their colleagues or the public), he was replaced by Diana Sarfati in 2022.

The role changed significantly after amalgamation, and it would be unfair to place any blame on Sarfati, but the institutional knowledge that Dunedin Hospital needed to be replaced predates all of these people, and yet none made it a priority.

It has existed as a Catch-22, a classic double-bind. Everyone wanted to take credit for a new shiny hospital, but no one wanted to be responsible for inevitable cost blowouts, delays in building, or bad PR of any kind.

This has now changed, slightly, thanks to pressure from the media and public, but even that is being misdirected and will result in no lessons being learned internally.

For something like this to go off the rails so spectacularly for as long as two decades, it needs a lot of things to come together - one of those being a media unable to grasp the size and scope of the issue.

In their 'What You Need To Know' section, Radio NZ published ‘Dunedin Hospital: A timeline of the redevelopment’ (https://www.rnz.co.nz/news/what-you-need-to-know/529431/dunedin-hospital-a-timeline-of-the-redevelopment). Their timeline starts in 2015 and is so light on details that it is completely misleading and borderline lacking in any merit.

If what they covered was truly all one needed to know about why Dunedin has lacked a fit-for-purpose fully functional hospital for at least twenty years, but really only 9 years for some reason, then a street protest and yelling at a PM who was living in the United States twenty years ago would fix everything.

This is a timeline that doesn't mention when issues with the current Dunedin Hospital first appeared, doesn't mention who is actually responsible for escalating such issues (both before and during DHB amalgamation), and only covers two governments.

Our media is doing what my former bosses regularly did - dumbing down an issue and avoiding the complex because it isn't advantageous to them, because acknowledging the truth would require doing something about it. It would take too much time to do research, so they just aggregate other people's reporting and label it original and vital.

Telling everyone to blame Luxon, or Ardern, baits in some clicks. Weaving a complex (true) story of an overly complex system that takes shortcuts and avoids immediate conflicts is far harder for people to digest and might be less appealing in our time poor age.

It's disheartening to see issues of significance used for point scoring, but it also is also a true reflection of the games we find ourselves unwitting victims of.

I've worked for Chuah, Bloomfield, Health NZ CE Margie Apa, Health NZ Commissioner Lester Levy, in three health boards, and in the office of one Health Minister and they are all intelligent and ambitious people.

They didn't choose to do nothing out of laziness, they chose it as a legitimate strategy for achieving their ends (which sadly weren't to 'leave the health system better off than when you inherited it’).

The real reason why we don't have a brand new Dunedin Hospital today is down to the perverse incentives baked into many public service entities, ones that prioritise immediate gratification for leaders and eschews long term thinking.

The real reason why we don't have any detailed or complex reporting into why we don't have a brand new Dunedin Hospital today, is because we don't have enough reporters singularly focused and committed to understanding this complex system.

I regularly worked with twenty journalists at this time, now only two are still health reporters while four (admittedly the least intellectually curious ones) are now public service comms people.

Dunedin Hospital is just one example, the more worrying crisis I saw during that first era was the then-impending workforce shortages that were known about for nearly as long, but there were many others from over a decade ago that don't get touched or reported on until it is too late.

This is ‘Why’ - a lack of accountability, the lack of attention and effort, and the lack of institutional knowledge that comes with two industries so rife with issues that anyone with an ounce of self-preservation in their being is desperate to leave.

It's hard to get a passing grade in a group assignment when everyone hates each other and when the lecturer is not posting results for over a decade.

I have no doubt that I, the 24 year old senior adviser in a room of managers and directors double my age, am the only person involved in any level of this who feels any guilt or sadness at the way this has all turned out.

Maybe the part of me that still cares wasn't as dead as I assumed.

But this Dunedin Hospital situation, the resulting coverage, and every online ‘expert’ have been the final pillow over its/my face.

I hope they privatise the hospital and cut unelected public servants out of the decision making process, at least then it might get built within the next twenty years then.