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GUEST BLOG: Ian Powell – Pharmac 's welcome transparency highlights need for real bold Government action

Hello Name Tag Sticker on White
The Pharmaceutical Management Agency (known as Pharmac) is a crown entity that decides, on behalf of New Zealandâs district health boards (DHBs), which medicines and pharmaceutical products are subsidised for use in the community and public hospitals (I use the words âmedicinesâ and âdrugsâ interchangeably below). DHBs are currently responsible for the provision of community and hospital healthcare for defined geographic populations (the Government intends to abolish them on 1Â July 2022).
Origins of Pharmac
Pharmac was established in 1993 by the Jim Bolger led National government as the one sensible and sustainable structure when New Zealand embarked on an ideologically driven seven years of trying unsuccessfully to run its public health system as if it was a competitive business market. It was recognised that in order to have some level of leverage in negotiations for medicines and other products with oversea ....

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GUEST BLOG: Ian Powell – How a leadership culture conflict escalated in New Zealand's public health system

Earlier this month the
Democracy Project hosted by Victoria University published my first article of a two-part series on a very bureaucratic coup against the chief executive and the rest of his senior management team at Canterbury District Health Board (CDHB).
Engagement vs bureaucratic centralist cum command and control leadership conflict
It is often the case that conflicts are driven by personality clashes. Despite perceptions and assertions to the contrary, primarily this escalating dispute involved conflicting leadership cultures between the Ministry of Health (MOH) and CDHB.
The former was bureaucratically centralist and top-down while the latter had a stronger emphasis on engagement with both others in the Canterbury health system and its own workforce. ....

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GUEST BLOG: Ian Powell – Bureaucratic centralism rules supreme in New Zealand health system restructuring

Hello Name Tag Sticker on White
I didnât see the decision to abolish all 20 district health boards (DHBs) coming. In mitigation nor didnât almost everyone else. Last Sunday the Minister penned an article downplaying structural change being part of his forthcoming announcement.
I made the mistake in my previous
Otaihanga Second Opinion posting of taking the Minister at face value; I was wrong. His announcement focused on structure when it should have been on system culture. However, I qualified it by adding that if his announcement was opposite to the tone of his article then the latter would be mere weasel words; and thatâs what they turned out to be. ....

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GUEST BLOG: Ian Powell – District Health Board considers directly employing general practitioners

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Like almost every economically developed country outside the âDisunited Statesâ, New ZeaÂland has a universal health system that endeavours to be accessible for all, comprehensive, high quality and affordable.
The country is well placed to achieve this because of its unitary political system and district health board structure, in which each DHB is responsible for ensuring the provision of both community (including primary) and hospital care for defined geographic populations. Our structure established to implement this comprehensive responsibility is an advance on many other universal health system structures such as the United Kingdom and Australia. ....

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GUEST BLOG: Ian Powell – Ministry of Health: feudal fiefdoms and a culture of obliviousness

Fiefdoms to obliviousness to organisational culture
This exposure got me to thinking whether, several Director-Generals later, the existence of Ministry fiefdoms had changed. It seems not. But there is more to the fiasco than this. In todayâs world fiefdoms within such an important institution as the Health Ministry indicate a high level of obliviousness. This goes to the heart of undermining the overall trust and confidence in the Ministry of government, the wider health sector (including health professionals, district health boards and non-government organisations) and the public.
Obliviousness has two different (not necessarily alternative) meanings. The first is lacking remembrance, memory, or mindful attention. This isnât the case in this instance. But the second, lacking active conscious knowledge or awareness (especially the latter) applies. ....

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