Reti’s Velvet Glove Wore Too Thin For PM’s Iron Fist

Friday, 31 January 2025, 2:11 pm
Opinion: Ian Powell

Arguably the most astute immediate response to the sacking of Dr Shane Reti as health minister, after only a little more than a year in the job, and his replacement by Simeon Brown, came from the chair of General Practice NZ, Dr Bryan Betty.

He emphasised Reti’s strength in understanding the complexity of the health system. The clear implication was that he was being replaced by someone with no or minimal understanding of this complexity.

The common theme running through the media coverage is that Reti was sacked because he wasn’t good enough at getting things done. On the other hand, as evidenced by his handling of the local government and transport portfolios, Brown does get things done.

Though intelligent, thoughtful, and possessing the quality commended by Dr Betty, Reti’s political antenna is lacking. In this sense, he is similar to former Labour health minister David Clark. He is also at times guilty of over-thinking issues – not a political attribute (under-thinking, however, can be). Political street wisdom is not his strength.

However, this is a simplistic interpretation. When he became health minister, Reti was acutely aware that the Labour government had badly botched its vertical centralisation-based restructuring. He rightly believed there was a need to devolve decision-making within Health NZ regionally, closer to where most healthcare is provided. Reti also recognised that the severe health workforce shortages were the main problem to be addressed.

However, he was stymied because he was not in Prime Minister Christopher Luxon’s inner circle. Their personalities and understanding were opposite. While Reti over-thought, at least in health, Luxon under-thought. In contrast to Reti, Luxon didn’t appreciate the complexity of the health system. Luxon is known to have said in closed circles that the problem with health is that it is led by health. This wasn’t Reti’s view.

Marginalisation by three critical events

There were three critical events that severely weakened Reti’s position within the health system, which led to undermining his credibility within government. First, he had to swallow a huge political rat by having to accept the coalition Government’s decision to repeal the 2022 legislation strengthening tobacco control; that is, if he were to become minister.

Despite being National’s health spokesman Reti was excluded from the negotiations that led to it being part of the National-NZ First coalition agreement. And despite being a massive blow to Reti’s credibility within the health system, not just the medical profession to which he belonged, the response of the Prime Minister and his inner circle was indifference.

The second event was the controversial appointment of Lester Levy, first as Health NZ board chair before he was quickly appointed commissioner, replacing the board. Previous board chair appointments had been handled through the health minister’s office. However, on this occasion, it was handled by the Prime Minister’s office, further marginalising Reti.

Luxon’s relationship with Levy is closer than with Reti. It goes back to before Luxon entered Parliament in 2020. Luxon rates Levy highly (much higher than most of those in the health system that know, or know of, him). They sing very much from the same song-sheet.

Levy has not been sufficiently discreet about this relationship by making it known that sometimes he met the Prime Minister without the health minister present.

Reti correctly believes that it takes a long-term approach to sustainably improve the health system. Levy believes that it can be done through a shorter-term approach based on slashing health spending and by him writing a plan for the health system to move forward (this was due last August but has yet to emerge).

The third event was Reti, in concert with Infrastructure Minister Chris Bishop (appearing to play the role of a ‘minder’), announcing the decision to break National’s election commitment for the rebuild of Dunedin Hospital. Instead the rebuild would be downsized to some yet-to-be-decided level. The critical uproar from health professionals, local governments and the public has been loud, persistent and ongoing.

Velvet glove and iron fist

When Luxon became leader of the National Party he inherited Reti as health spokesman. But he had no good reason to replace him. Reti knew the health system well and had a good understanding of the issues. Being likeable also helped. This made it logical that he then became health minister.

As health minister, Reti could have been the velvet glove covering the iron fist of the Government’s approach to the health system. But this kind of velvet glove requires duplicity, which is not part of his skillset.

Further, the velvet has become very threadbare. The continual public revelations of various cost-cutting measures, including the ‘downsizing’ of the Dunedin Hospital rebuild (‘slash and burn’ is another descriptor), initiated by Levy have fully exposed the reality of the iron fist.

Increasingly this has also exposed the false claim that this cost-cutting would not affect patient services. Try getting a health professional to believe that claim. Even a duplicitous and street-wise health minister could not have prevented the velvet from becoming threadbare.

Flawed rationale

Consequently Shane Reti’s demotion was inevitable. The only surprise was its earlier-than-expected timing. However, the rationale for his demotion (not getting things done fast enough) was unfairly applied to him.

Responsibility for getting things done rested at the governance and operational level. That was the argument for appointing Lester Levy as commissioner, whose role has become a blend of governance and operational. If there was justification for a sacking over failure to get things done, then Levy should have been the one to go. But this is all about politics, not logic.

The problem with the ‘getting things done’ argument is that it confuses ‘getting things done’ with ‘getting things done well’. Andrew Little became health minister after the 2020 election because he could get things done. He did, but very poorly. He took a simplistic approach, believing that if you vertically centralise a health system then ipso facto it would be improved. We are now living with the consequences of his blunder.

The Government is on strong grounds for blaming this restructuring for much of the crisis the health system is now in.

But it is ironic that Simeon Brown now has the health portfolio in order to get things done. He blames the crisis on the Labour government’s restructuring. But this restructuring occurred on the watch of another health minister who also got things done.

Should have gone to Specsavers

What can we expect from the new health minister? Another shared characteristic with Little is the absence of experience in the health system and the lack of appreciation of complexity. Brown may have got things done in local government (but is it that difficult to appoint a Crown observer to a city council?) and transport (but is it that difficult to stop decreasing speed limits outside schools?).

Whether Simeon Brown did things well in these portfolios is another matter. More relevant to health is that in both portfolios he has demonstrated either a lack of understanding or indifference to the complexity of relationships, both between local government and population wellbeing and between transport and climate change. This is not an encouraging pedigree for the health system.

There are no quick-fixes in health that lead to sustainable systems improvement and more accessible and better healthcare. Unfortunately, the narrow lens through which Luxon and his Government see the health system suggests they should have first gone to Specsavers. Brown should cycle there quickly – this would be better for his and the health system’s wellbeing.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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