How not to lead: a lesson from ministers in trouble
Colin James's NZ Herald column for 11 December 2007
One symptom of a government in trouble is a propensity to whack public servants.
Symptom: Trevor Mallard, under pressure over the Clare Curran affair, grossly abused Erin Leigh. Mallard lost: he now looks in need of deep, rehabilitative rest. The government lost: bullying is bad and looks bad.
Symptom: David Cunliffe, under pressure from "crisis" stories about Wellington hospital, condemned the hospital's board, which is in part government-appointed.
Unless Helen Clark gets back on top of her government's political management quickly next year, we can expect many more such symptoms. Across the floor of the House the remnants of the last National government happily recognise the malady.
The real story about Wellington hospital is systemic. Not just that hospital, last week's excitement. Hospital services as a whole.
The Australian election also featured hospitals "in crisis". John Howard said he would take one over to fix it. Kevin Rudd said he would fix the hospitals if the states, which run them now, didn't.
Health services feature in the United States presidential campaign. Americans spend one and a-half times the percentage of GDP we do on "health care" for a shorter average life expectancy. And they have the world's leading technology and top organisational theorists.
Part of Cunliffe's problem is Cunliffe and his predecessors: first, a hybrid governance model, which defies organisational logic; second, under-resourcing, compounded by, third, tough instructions not to overspend; fourth, ministers' encouragement to voters to believe they can have all the "health" repairs they want for "free", compounded by, fifth, Cunliffe's bragging in Parliament that he is "running the show".
After eight years "running the show" and massive fiscal surpluses year after year, the Clark government has had time and scope to fix systemic hospital shortcomings. Now the National party's polling is showing it is thought a better bet than Labour to ensure adequate health services.
If that polling correctly reflects public opinion, Clark's government's prognosis looks grim. Labour usually beats National on social issues even in bad years.
The government is not to blame for human error. No one lives an error-free life and all decent people will allow that some things go wrong in the best of systems and with the best of intentions. And in a hospital, unlike other places, error can mean death.
But the government is to blame for systemic error. If the government is determined to own the hospitals, it is the government's job to ensure they are run efficiently and effectively -- which means putting in good governance systems and stumping up adequate resources.
Cunliffe was to announce an intervention after this went to press. But that will leave unfronted the deeper issue, which is his, not the board's, responsibility: the hard choices "health" poses for all of us.
The hard fact is that supply cannot meet demand. That is true of super-rich United States and very rich Australia as it is of this country, where hospitals are under-resourced and staffs underpaid. Science and technology promise miracles, at vast expense. Taxpayers cannot afford all the miracles. Result: a shortfall. Result of that: misery.
There will come a day when a government has to confess it can't provide complete and perfect care and repairs and states what it can provide. National Health Minister Simon Upton toyed with doing that in the early 1990s and set up a committee to identify a core of services the government would guarantee, as a United States state had done. But ministers were spooked by the state's rapid retreat from its core after a media frenzy when a child was denied a treatment.
For now, ministers join in gunning for health professionals and managers when things go awry. Wellington hospital set up a system to avert future errors by learning from past errors and got shock-horror-crisis media treatment: 23 error deaths in 86,000 admissions. How many journalists get it that right? How many politicians do?
How many hospital staff will cooperate with that reporting now? Who will lose? Future patients.
A real leader backs the servants and quietly works to get the systems right.
The public service throws up more such leaders than their political masters deserve. They are exemplified by Peter Hughes who took the Child, Youth and Family service into his Ministry of Social Development two years ago and has quietly been rebuilding it. There are still human errors but the "crisis" stories have subsided.
Last Tuesday, at his annual "stakeholders" drinks, Hughes said of his 10,000 staff: "They are so good and I am so undeserving."
Politicians laid low by the government-in-trouble virus turn that round: "I am so good and they are so undeserving".
Public servants could usefully invest in body armour for the year of hot politics ahead. The government has banned smacking children but belabouring servants is OK.
It's a case of "government, heal thyself".