Another observation on the destruction of CDHB and the undermining of our Health systems

In an article on lessons from the extremely successful leadership team at the Canterbury District Health Board (CDHB), Brian Easton commented on an earlier column where he reported its demise from excessive and insensitive interference by centralised Wellington bureaucracy. 

This article builds on the writing of Ian McCrae, who was founder and former CEO of Orion Health: Bugger, I’m the New Minister of Health, which also drew lessons from the CDHB experience. 

It then reports an insightful comment to McCrae’s article by a prominent Canterbury surgeon, Saxon Connor about the high level of trust at CDHB: 

This is spot on. But what it doesn’t allude to is that the approach didn’t happen by chance. There was almost a decade of ‘trust building’ that allowed a system network to develop which embraced change based on underlying values of respect, empathy, and psychological safety. 

However, my observation is since the change we have seen loss of those networks, trust, and respect. People are now disengaging on [a] daily basis. The old way of working cannot simply be turned back on. It will require starting from scratch to rebuild trust. Paraphrasing David Meates [former Canterbury chief executive] “Change can only happen at the speed of trust”. I don’t think people quite yet understand what they have lost from the Canterbury health system over the last two years. 

Brian Easton commented that “the trust did not occur overnight. It took longer than a decade. The turning point was the 2006 arrival of a new, very experienced, chief executive, Gordon Davies, who knew the health system well and understood the importance of both relationships and good engagement with health professionals. His work was built upon by his successor, Meates, whose leadership finished in 2020, when the Wellington approach made it impossible for him and his senior leadership term to continue.” 

One of my reasons for being involved in Local Government was a personal commitment to “subsidiarity”. A philosophy misunderstood by most Central Government MP’s, especially once they come under the domination of Wellington bureaucrats. 

Easton writes about “subsidiarity”: 

Critical to this analysis is the notion of the ‘principle of subsidiarity’, that is central government should only perform those tasks that cannot be performed at a more local level. That does not only apply to central government. Anywhere in a hierarchy, subsidiarity says activities should be delegated to the lowest possible level. Sure, they are going to make mistakes down there, but so do those higher up – bigger bogups. 

It is a cultural issue. You cannot impose trust and good working practices. They develop from the bottom. Centralisers have tried; Stalin and his goons did not succeed at all. Our central institutions have done little better. 

Here’s the entire article There Are Wider Lessons to be Learned From the Failures in the Management of the Health System — Pundit 

As we sit waiting for operations, or the chance to see public specialists, or listen to frustrated staff of the newly created health structures think back to when the CDHB wasn’t run from Wellington. Or under a series of misguided Ministers thinking that it’s them who control the Ministry of Health.