It sounds dramatic, sacking the two remaining members of the board and changing newly-minted chairman Prof Lester Levy’s role to deficit-busting commissioner.
In the next 12 months, possibly with the help of up to three deputies, he is expected to stop the health agency overspending by $130 million a month, saving about $1.4 billion.
Health Minister Dr Shane Reti says he first learned about the deteriorating financial position in March, and, in the months since, the situation has worsened.
It is difficult to understand, if this is such a big deal, why he did not tell us earlier.
After all, Dr Reti appointed a crown monitor to the organisation soon after taking office last year.
In the district health board days, deficits were a fact of life, despite myriad programmes to try to improve efficiency.
There is opaqueness about what has suddenly caused this overspend.
The government says the issues stem from mismanaged health reforms, an overly centralised operating model, limited oversight, and fragmented administrative data systems unable to identify risks until it was too late.
Dr Reti drew attention to the 2500 increase in the last six years in back-office staff numbers and 14 layers of management when he said there should be six.
No detail has been provided about what those layers involve or what roles any extra back-office people are doing.
What if many of them have been trying to improve the dreadful data systems?
We have been promised any claw-back in spending will not affect frontline service delivery, but when we are already hearing from clinicians the freeze on hiring is affecting their services, it is hard to believe.
Indeed, HNZ chief executive Margie Apa would have raised eyebrows on the embattled frontline when she said this week the agency had ‘‘over-corrected’’ workforce shortages, including in nursing.
Dr Reti says there will be reconnection with frontline staff to reduce the distance between them and decision-making because they know best what resources they need, what workforce they need, and how to adjust to meet acute need. He does not say what will happen if that reconnection suggests they need more spending on staff and facilities.
The government crows about its increased spending on health, as every government does, although always to a chorus of arguments that it is not enough.
This year, Labour says the Budget did not allow adequately for cost inflation and population growth.
However, Prof Levy is convinced he is dealing with a bloated bureaucracy and that HNZ has enough money to reduce waiting times if the system changes its focus and operating model.
His greater emphasis on the four regions (the South Island is one of them) with four deputy chief executives having financial accountability and power to make decisions, reporting to the chief executive, will be welcomed. We would hope, however, this will not be an excuse to promote competition rather than collaboration between regions.
The lack of transparency about what goes on at HNZ, something which has concerned us since its inception, does not help anyone get to grips with the competing arguments.
It is a bit rich for former health minister Labour’s Ayesha Verrall to now be calling for HNZ to reinstate the previous district health boards’ practice of publishing monthly accounts with a breakdown of staff and costs and for board meetings to be public. (A brief section of HNZ board meetings were made public but most was in closed session).
That could have been required within the Pae Ora (Healthy Futures) Act, and this was suggested by submitters on the Bill, but it was not included when the Labour government passed it.
It would be great to see more openness at all levels of the organisation, but that does not seem to be part of Dr Levy’s brief.
